BACKGROUND: The ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) has recently been reported as an independent prognostic parameter in heart failure. The TAPSE/PASP ratio has not been evaluated in detail in patients with pulmonary arterial hypertension (PAH). METHODS: We analyzed TAPSE/PASP in 290 patients with PAH entered into the Giessen Pulmonary Hypertension Registry between November 2003 and July 2014. The prognostic relevance of TAPSE/PASP was assessed with multivariate Cox regression models, adjusting for clinical covariates, echocardiographic parameters, or hemodynamics, and was confirmed by Kaplan-Meier analyses. RESULTS: When stratified by tertile of TAPSE/PASP (low: <0.19mm/mmHg; middle: 0.19-0.32mm/mmHg; high: >0.32mm/mmHg), patients in the low tertile showed significantly compromised hemodynamic, functional, and echocardiographic status compared with patients in the middle and high tertiles. In all multivariate models, TAPSE/PASP remained independently associated with overall mortality: the hazard ratio (95% confidence interval) was 1.87 (1.35-2.59) when adjusting for clinical covariates (p<.001), 5.21 (2.17-12.5) when adjusting for echocardiographic parameters (p<.001), 1.92 (1.30-2.83) when adjusting for hemodynamics (p=.001), and 4.13 (2.02-8.48) when adjusting for a selection of previously identified independent echocardiographic and hemodynamic prognostic indicators (p<.001). Kaplan-Meier analyses showed better overall survival in the middle and high tertiles versus the low tertile (log-rank p<.001). CONCLUSIONS: The TAPSE/PASP ratio is a meaningful prognostic parameter in patients with PAH and is associated with hemodynamics and functional class.
- Tello, K.
- Axmann, J.
- Ghofrani, H. A.
- Naeije, R.
- Narcin, N.
- Rieth, A.
- Seeger, W.
- Gall, H.
- Richter, M. J.
Keywords
- Pasp
- Pulmonary hypertension
- Right ventricular contractile function
- Survival
- Tapse