TAPSE-to-tricuspid regurgitant pressure gradient ratio and early mortality in hospitalized heart failure

The TAPSE-to-TRPG ratio may summarize right-ventricular function relative to Doppler pressure load, but selective measurement and significant tricuspid regurgitation (TR) may limit its value.

In linked MIMIC-IV and MIMIC-IV-ECHO data, we studied first heart-failure admissions with early echocardiography. Complete-case, inverse-probability-weighted, and multiply imputed models evaluated in-hospital and 30-day mortality; incremental performance, TR, cardiac index, timing, and competing discharge were examined.

Of 16,240 eligible patients, 2356 had TAPSE, TRPG, and numeric LVEF. Lower ratio was associated with in-hospital (OR 1.45, 95% CI 1.19-1.76) and 30-day mortality (OR 1.55, 95% CI 1.30-1.85), with consistent sensitivity estimates. TAPSE alone and separate-component models had greater cross-validated discrimination. The in-hospital association was not statistically evident in moderate-or-greater TR.

Lower ratio identified higher early mortality but did not outperform its components; it remains hypothesis-generating rather than a validated incremental metric.