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

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.