Echocardiographic Stratification of Diuretic Response via TAPSE- PASP Integration in Decompensated Heart Failure

Background: Right ventricular (RV) function is a key determinant of the prognosis of heart failure (HF), particularly because of its role in maintaining forward flow and renal perfusion. Echocardiographic indices, such as tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP), provide non-invasive insights into RV performance and pulmonary vascular load. However, their stand-alone interpretations have limitations. This study introduced a composite TAPSE-PASP (TP) score and evaluated its relationship with diuretic response, measured via spot urinary sodium concentration. Methods: This retrospective single-center study evaluated 81 hospitalized patients with HF. Standard transthoracic echocardiography was performed, and the TAPSE, PASP, and derived indices (TAPSE/PASP ratio, TAPSE × PASP product) were recorded. A novel TP score was developed by combining quartile-based categorizations of the TAPSE/PASP ratio and the product of TAPSE and PASP. The diuretic response was assessed by measuring urinary sodium at two hours post-loop diuretic administration. The patients were stratified as good or poor responders based on a urinary sodium threshold of 50 mmol/L. Results: Patients in the poor diuretic response group had significantly lower urinary sodium levels (28.1 ± 11.3 vs. 95.5 ± 24.1 mmol/L, p < 0.001) and a higher incidence of worsening renal function (69% vs. 23%, p < 0.001). While individual TAPSE and PASP-based parameters showed only modest associations with diuretic response, the TP score demonstrated a significant correlation with urinary sodium excretion (r = 0.248, p = 0.032). Lower TP scores are associated with impaired RV function and suboptimal decongestion. Conclusion: The TP score, which integrates RV systolic function and pulmonary vascular load, correlates with diuretic efficacy in patients with HF. It may serve as a useful echocardiographic marker for identifying patients at risk of diuretic resistance and for guiding decongestive strategies.