Association between the TAPSE to PASP ratio and short-term outcome in patients with light-chain cardiac amyloidosis

• Published in: International journal of cardiology Vol. 387; p. 131108
• Main Authors: Yu, Fangcong, Cui, Yawei, Shi, Jiaran, Wang, Longbo, Zhou, Yunping, Ye, Tianxin, Ye, Zhehao, Yang, Jinxiu, Wang, Xingxiang
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.09.2023
• Subjects: Light-chain cardiac amyloidosis (AL-CA); Short-term outcome; Systolic blood pressure(SBP); Tricuspid annular plane systolic excursion(TAPSE);pulmonary arterial systolic pressure(PASP); Light-chain cardiac amyloidosis (AL-CA); Short-term outcome; Systolic blood pressure(SBP); Tricuspid annular plane systolic excursion(TAPSE);pulmonary arterial systolic pressure(PASP)
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2023.05.058

Amyloid light-chain cardiac amyloidosis (AL-CA) patients experiencing RV failure have a poorer prognosis. The echocardiographic ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) serves as a non-invasive proxy for evaluating the coupling between the right ventricle (RV) and pulmonary circulation. The aim of this study was to assess the association between the TAPSE/PASP ratio and short-term outcome in patients with AL-CA. Seventy-one patients diagnosed with AL-CA were enrolled in this retrospective cohort study.Short-term outcome was defined as 6-month all-cause mortality. Receiver operating characteristic (ROC), logistic regression, and Kaplan-Meier analysis were used in this study. Among seventy-one patients with AL-CA (mean age, 62 ± 8 years, 69% male), 17 (24%) died within the first 6 months (mean follow-up period 55 ± 48 days). Linear regression analysis indicated that the TAPSE/PASP ratio was correlated with RV global longitudinal strain (r = −0.655, p < 0.001), RV free wall thickness (r = −0.599, p < 0.001), and left atrial reservoir strain (r = 0.770, p < 0.001). The time-dependent ROC and the area under the curve (AUC) showed that the TAPSE/PASP ratio was a better predictor (AUC = 0.798; 95% confidence interval (CI): 0.677–0.929) of short-term outcome than TAPSE (AUC = 0.734; 95% CI: 0.585–0.882) and PASP (AUC: 0.730; 95% CI: 0.587–0.874). Multivariate logistic regression showed that patients with the worse TAPSE/PASP (< 0.47 mm/mmHg) and lower systolic blood pressure (< 100 mmHg) had the highest risk of dying. The TAPSE/PASP ratio is associated with the short-term outcome of patients with AL-CA. The combination of TAPSE/PASP ratio < 0.474 mmHg and SBP < 100 mmHg could identify the subgroup of patients with AL-CA at elevated risk of poor prognosis. •The echo-derived TAPSE to PASP ratio provides superior prognostic information compared to TAPSE and PASP in AL-CA patients.•Calculating the TAPSE/PASP ratio offers an easily applicable approach for assessing short-term outcomes in AL-CA patients.•A TAPSE/PASP ratio < 0.474 mmHg combined with SBP < 100 mmHg indicates a high risk of poor prognosis and requires immediate attention.Should you have any further questions or require additional modifications, please let us know.