Echocardiographic Stratification of Diuretic Response via TAPSE–Pulmonary Artery Systolic Pressure Integration in Decompensated Heart Failure

Objective: Right ventricular (RV) function is a key determinant of prognosis in heart failure (HF). Although echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) are widely used, their interpretation in isolation has limitations, and the relationship between right ventricular–pulmonary arterial (RV–PA) coupling and diuretic response remains insufficiently defined. We hypothesized that a composite TAPSE–PASP (TP) score would better reflect RV–PA coupling and be associated with the natriuretic response. This study aimed to evaluate the association between the TP score and diuretic response, as assessed by spot urinary sodium.
Method: This retrospective, single-center study included 81 hospitalized patients with HF. Standard transthoracic echocardiography was performed to measure TAPSE, PASP, and derived indices. A TP score was created using quartile-based categorization. Diuretic response was assessed by spot urinary sodium. Patients were classified as good or poor responders using a threshold of 50 mEq/L.
Results: Poor responders had lower spot urinary sodium levels (28.1 ± 11.3 vs. 95.5 ± 24.1 mmol/L, p < 0.001) and a higher prevalence of worsening renal function (69% vs. 23%, p < 0.001). Individual measures (TAPSE/PASP and TAPSE × PASP) were not significantly associated with diuretic response, whereas the TP score showed a weak but significant correlation with urinary sodium (r = 0.248, p = 0.03). Lower TP scores were associated with impaired RV function markers and a lower natriuretic response.
Conclusion: The TP score integrates RV systolic performance and pulmonary vascular load and demonstrated a weak but significant association with diuretic response in patients with HF. Given the retrospective design and lack of external validation, these findings should be considered exploratory and hypothesis-generating.

Keywords: Diuretic response, echocardiography, heart failure, right heart, urinary sodium