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Introduction <p>Right ventricular–pulmonary artery (RV-PA) coupling evaluates the relationship between right ventricular contractility and afterload. It is normal when both are well-matched. A reduction in RV contractility or an increase in RV afterload leads to RV-PA uncoupling, decreasing left ventricular filling, stroke volume, and causing peripheral hypoperfusion and congestion. The TAPSE/PASP ratio is a reliable non-invasive method to assess this coupling. An impaired TAPSE/PASP ratio is associated with poor prognosis in conditions of elevated RV afterload, but its role in acute coronary syndrome (ACS) is unclear.</p> Aim <p>The aim of this study is to investigate the in-hospital prognostic value of the TAPSE/PASP ratio and the predictors of a low TAPSE/PASP ratio.</p> Methods <p>This retrospective, pilot study included 152 patients admitted for ACS (77.6% STEMI, 22.4% NSTEMI) between November 2023 and March 2025, with available TAPSE/PASP data from echocardiography performed at admission. The primary objective was to assess whether the TAPSE/PASP ratio predicts in-hospital major adverse cardiovascular events (MACE). Secondary objectives included evaluating whether TAPSE/PASP predicts in-hospital ventricular arrhythmias, intraventricular thrombosis, prolonged hospital stay, and identifying predictors of a low TAPSE/PASP ratio.</p> Results <p>TAPSE/PASP &lt; 0.55 was significantly associated with MACE and prolonged hospital stay in univariate analysis, but not in multivariate analysis. TAPSE/PASP &lt; 0.55 was largely explained by E/e′ &gt;14 (OR 6.600; <i>p</i> = 0.0008), RV involvement (OR 9.430; <i>p</i> = 0.0007), and age &gt;75 years (OR 3.243; <i>p</i> = 0.0389).</p> Conclusions <p>Low RV-PA coupling (TAPSE/PASP &lt; 0.55) is associated with MACE and prolonged hospital stay in ACS, but lacks independent prognostic value in multivariate analysis.</p> Graphical abstract <p>In-hospital prognostic value of TAPSE/PASP ratio in patients admitted for ACS. TAPSE: tricuspid anular peak systolic excursion. PASP: pulmonary artery systolic pressure; ACS: acute coronary syndromes</p>

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Bridging the Gap: Exploring Right Ventricular-Pulmonary Artery Coupling in Acute Coronary syndrome–A Pilot Study

  • 期刊论文

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  • 发表日期：

    2025年12月15日

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  • Linda Piras,
  • Nicola Tartaglia,
  • Giuliano Tocci,
  • Emanuele Barbato,
  • Allegra Battistoni

摘要

Introduction

Right ventricular–pulmonary artery (RV-PA) coupling evaluates the relationship between right ventricular contractility and afterload. It is normal when both are well-matched. A reduction in RV contractility or an increase in RV afterload leads to RV-PA uncoupling, decreasing left ventricular filling, stroke volume, and causing peripheral hypoperfusion and congestion. The TAPSE/PASP ratio is a reliable non-invasive method to assess this coupling. An impaired TAPSE/PASP ratio is associated with poor prognosis in conditions of elevated RV afterload, but its role in acute coronary syndrome (ACS) is unclear.

Aim

The aim of this study is to investigate the in-hospital prognostic value of the TAPSE/PASP ratio and the predictors of a low TAPSE/PASP ratio.

Methods

This retrospective, pilot study included 152 patients admitted for ACS (77.6% STEMI, 22.4% NSTEMI) between November 2023 and March 2025, with available TAPSE/PASP data from echocardiography performed at admission. The primary objective was to assess whether the TAPSE/PASP ratio predicts in-hospital major adverse cardiovascular events (MACE). Secondary objectives included evaluating whether TAPSE/PASP predicts in-hospital ventricular arrhythmias, intraventricular thrombosis, prolonged hospital stay, and identifying predictors of a low TAPSE/PASP ratio.

Results

TAPSE/PASP < 0.55 was significantly associated with MACE and prolonged hospital stay in univariate analysis, but not in multivariate analysis. TAPSE/PASP < 0.55 was largely explained by E/e′ >14 (OR 6.600; p = 0.0008), RV involvement (OR 9.430; p = 0.0007), and age >75 years (OR 3.243; p = 0.0389).

Conclusions

Low RV-PA coupling (TAPSE/PASP < 0.55) is associated with MACE and prolonged hospital stay in ACS, but lacks independent prognostic value in multivariate analysis.

Graphical abstract

In-hospital prognostic value of TAPSE/PASP ratio in patients admitted for ACS. TAPSE: tricuspid anular peak systolic excursion. PASP: pulmonary artery systolic pressure; ACS: acute coronary syndromes