103 Prevalence, determinant and prognostic value of TAPSE in an outpatient CHF clinic

Abstract

Few reports exist of the prognostic significance of right ventricle function (RV) variables in chronic heart failure (CHF) and the broad range of left ventricle (LV) ejection encountered in clinical practice. To determine the prevalence, predictors, and prognostic value of RV function measured by the tricuspid annular plane systolic excursion (TAPSE) in patients with symptoms suggesting CHF. Analysis of referrals for diagnosis and management of CHF to a specialist clinic serving a local community. Of 1547 patients studied, mean (SD) age was 71 ± 11 years, 48% were women, mean LV ejection fraction (LVEF) was 47 ± 16% and median (IQR) TAPSE was 18.5 mm (14.0–22.7). LVEF was >45% in 47% and 67% were classified as heart failure. During a median (IQR) follow-up of 63 (41–75) months, overall mortality was 34%. In multivariable analysis, increasing age, NT-proBNP, NYHA class, atrial fibrillation, right atria volume, systolic pulmonary artery pressure (sPAP), lower TAPSE, lower diastolic blood pressure (DBP), lower haemoglobin, diagnosis of COPD, and digoxin and betablocker treatments were all associated with an adverse prognosis but not HF class. A receiver operator curve analysis investigating the relationship between TAPSE and prognosis showed an area under the curve of 0.69 (95%CI (0.64–0.74); p = 0.0001), with a value of 15.9 mm of TAPSE best able to predict outcome. TAPSE<15.9 mm was most strongly associated when NTproBNP was not included in the model with raised in sPAP, DBP, heart rate and with decreased of BMI, eGFR and systolic BP, and presence of atrial fibrillation, ischaemic heart disease and with the severity of mitral regurgitation and S-HF. In patients with symptoms of chronic heart failure, TAPSE, but not variables related to LV systolic function, was an independent predictor of outcome. This simple measure could be used to stratify patient risk in routine clinical practice.