Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Outcome of Patients with Cardiogenic Shock and Prior Right Ventricular Impairment Represented by Decreased TAPSE and TAPSE/PASP ratio

J. Rusnak1, T. Schupp1, K. J. Weidner1, M. Ruka1, S. Egner-Walter1, J. Forner1, T. Bertsch2, M. Kittel3, K. A. Mashayekhi4, P. Tajti5, M. Ayoub6, M. Behnes1, I. Akin1

1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg; 3Institut für klinische Chemie, Universitätsmedizin Mannheim (UMM), Mannheim; 4Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; 5Gottsegen György National Cardiovascular Center, Budapest, HU; 6Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Objective: The study investigates the prognostic impact of prior decreased ratio of TAPSE/PASP (tricuspid annular plane systolic excursion/pulmonary artery systolic pressure) and TAPSE in patients with cardiogenic shock (CS).   Background: In patients with pulmonary artery hypertension as well as in critical ill patients decreased TAPSE and TAPSE/PASP ratio are known to be negative predictors. However, studies regarding the prognostic impact in patients with CS admitted to intensive care unit (ICU) is limited.   Methods: Consecutive patients with CS from June 2019 to Mai 2021 were included monocentrically. Medical history including echocardiographic parameters such as TAPSE and PASP were documented for each patient. Firstly, the diagnostic value of TAPSE and TAPSE/PASP ratio were tested. Secondly, the prognostic values were investigated regarding the impact on 30-day all-cause mortality. Statistical analyses included univariable t-test, Spearman´s correlation, C-statistics, Kaplan-Meier analyses, and Cox proportional regression analyses.   Results: 90 patients with CS and prior to ICU documented values of TAPSE and TAPSE/PASP ratio were included. TAPSE and TAPSE/PASP ratio were both able to predict 30-day survival in different risk models. TAPSE (p = 0.003) and TAPSE/PASP ratio (p = 0.010) were significantly lower in non-survivors after 30 days. In Kaplan Meier analyses patients with TAPSE/PASP ratio < 0.4 mm/mmHg (45.6 % vs. 75.8 %; log-rank p = 0.006) as well as TAPSE < 18 mm (42.0 % vs. 75.0%; log-rank p = 0.004) showed a significantly higher 30-day all-cause mortality. Both parameters showed significant association with 30-day all-cause mortality in univariable cox-regression. However, TAPSE/PASP < 0.4 mm/mmHg was not able to predict 30-day all-cause mortality in multivariable cox-regression, whereas TAPSE < 18 mm was still significantly associated (HR: 2.177; CI 1.054 – 4.497; p = 0.036).   Conclusion: In patients presenting with CS, TAPSE/PASP ratio did not improve risk prediction compared to TAPSE alone, when assessed prior to ICU admission. Furthermore, in multivariable cox-regression solely TAPSE was able to predict 30-day all-cause mortality.

https://dgk.org/kongress_programme/jt2023/aP2127.html