The prognostic value of TAPSE/sPAP in Acute coronary syndrome-related cardiogenic shock

Résumé fourni par la source

Abstract Introduction The prognosis of Acute coronary syndrome-related cardiogenic shock (ACS-CS) remains poor, especially when the systolic function of the right ventricle is impaired. However, given the high sensitivity of the RV to its afterload, the function of the RV cannot be interpreted without analysing the RV-pulmonary artery coupling (RV-PA). Purpose We analyzed the prognostic value of the ratio of tricuspid annulus systolic excursion to pulmonary artery systolic pressure (TAPSE/sPAP) in patients with ACS-CS, since it is a good non-invasive assessment of RV-PA coupling. Methods We reviewed the medical data of patients admitted to our CICU over a 4-year period for ACS.We excluded patients without cardiogenic shock. We defined ACS-CS according to the SCAI (Society for Cardiovascular Angiography & Interventions) classification. TAPSE/sPAP measured by echocardiography within the first 24 h of hospitalization. Using the receiver characteristic curve, we analyzed the best TAPSE/sPAP threshold for the primary endpoint defined as a composite of all-cause mortality, readmission for heart failure or non-fatal ACS at 1 year. We then performed a multivariable proportional hazards COX regression analysis adjusted for creatinine level, ejection fraction, TAPSE/sPAP ratio and myocardial revascularisation. Results We included in our study 134 patients, with a mean age of 68,16 years, 67,9% male, mean length of hospital stay 5.11 days, 42.5% hypertensive, 36.6% diabetic type II. The mean EF was 33 +/- 12%, the creatinine level mean was 21+/-19 mg/l, and myocardial revascularisation was performed in 40%. ROC analysis showed that the best TAPSE/sPAPS ratio threshold associated with the primary endpoint was 0.4 mm/mmhg with a specificity of 74% and a sensitivity of 60% (p<0.001) (Figure 1). The primary outcome was observed in 81(60.4%) patients, with 33 (45,8%) patient with TAPSE/sPAPS>0,4 and 48 (77,4%) patient with TAPSE/sPAPS<0,4 (Hazard ratio at 2.07 (95%CI; 1.33-3.20; p=0.001) before adjustment) The kaplein-meier survival analysis showed a significant difference between the patient of the principal endpoint according the TAPSE/sPAPS ratio with log-Rank test pValue at 0,002 (Figure 2).The result was still statistically significant after adjustment for ejection fraction, creatinine level and myocardial revascularisation (hazard ratio of 1.79 (95%CI; 1.08-2.97; p=0.024). Conclusion A TAPSE/sPAP ratio < 0.40 mm/mmHg assessed by early echocardiography during ACS-CS is independently associated with prognosis at 1 year, suggesting the important involvement of RV-PA coupling in the severity of cardiogenic shock.FIGURE 1 FIGURE 2

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.