title: Tricuspid Annular Plane Systolic Excursion in Acute Decompensated Heart Failure: Relevance for Risk Stratification.
abstract: Although the prognostic value of right ventricular dysfunction in chronic heart failure (HF) has been studied extensively, it remains insufficiently characterized in the setting of acute decompensated HF (ADHF). We sought to assess whether measurement of tricuspid annular plane systolic excursion (TAPSE) or TAPSE-to-estimated pulmonary arterial systolic pressure (ePASP) ratio allows improvement of risk prediction in ADHF.
  
  
  
  Four hundred ninety-nine patients with ADHF were studied. Cox regression analyses were used to analyze the association of TAPSE and TAPSE-to-ePASP ratio with 1-year mortality and logistic regression analyses to analyze the association of the 2 variables of interest with adverse in-hospital outcome (AiHO) (in-hospital death plus worsening HF).
  
  
  
  During the 365-day follow-up, 143 patients (28.7%) died. At univariable analysis, both TAPSE (P = 0.026) and TAPSE-to-ePASP ratio (P < 0.0001) were significantly associated with 1-year mortality. At multivariable Cox analysis, age (P = 0.0270), ischemic heart disease (P = 0.020), systolic blood pressure (P = 0.006), log N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (P < 0.0001), serum sodium levels (P = 0.001), and hemoglobin levels (P = 0.001) at admission were independently associated with 1-year mortality. Adjusting for these covariates, neither TAPSE (P = 0.314) nor TAPSE-to-ePASP ratio (P = 0.237) remained independently associated with 1-year mortality. Eighty-three patients (16.6%) had an AiHO. At multivariable logistic regression analysis, the TAPSE-to-ePASP ratio was independently associated with an AiHO (P = 0.024). The association of TAPSE alone or ePASP alone was not statistically significant.
  
  
  
  Our data strongly suggest that early assessment of TAPSE or TAPSE-to-ePASP ratio does not improve prediction of 1-year mortality over other key risk markers in ADHF. Nonetheless, the TAPSE-to-ePASP ratio did appear to be independently associated with AiHO.
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. Electronic address: domenico.scrutinio@fsm.it.
authors: Domenico
authors: D
authors: Scrutinio
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors: Raffaella
authors: R
authors: Catanzaro
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors: Daniela
authors: D
authors: Santoro
authors: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy; San Raffaele Scientific Institute and University, Milan, Italy.
authors: Enrico
authors: E
authors: Ammirati
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors: Andrea
authors: A
authors: Passantino
authors: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Fabrizio
authors: F
authors: Oliva
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Montescano, Pavia, Italy.
authors: Maria Teresa
authors: MT
authors: La Rovere
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Montescano, Pavia, Italy.
authors: Maria
authors: M
authors: De Salvo
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
authors: Daniela
authors: D
authors: Guzzetti
authors: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
authors: Raffaella
authors: R
authors: Vaninetti
authors: "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy.
authors: Mario
authors: M
authors: Venezia
authors: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Maria
authors: M
authors: Frigerio
mesh_terms: D000367:Age Factors; D000368:Aged; D062186:Arterial Pressure; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011651:Pulmonary Artery / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012964:Sodium / Q000097:blood; D013318:Stroke Volume; D013599:Systole / Q000502:physiology*; D014261:Tricuspid Valve / Q000503:physiopathology*; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology; D016278:Ventricular Function, Right / Q000502:physiology
chemical_list: D006454:Hemoglobins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D012964:Sodium