TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension

BACKGROUND: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-PA coupling evaluated by the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) improves risk assessment scores for survival prediction. METHODS: A total of 677 consecutive patients with PAH (55% idiopathic) were prospectively enrolled with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months (interquartile range, 180-344 days) after initiation of targeted therapies in 11 Italian centers. European Society of Cardiology/European Respiratory Society guidelines-derived risk scores and REVEAL 2.0 (US Registry to Evaluate Early and Long-Term PAH Disease Management 2.0) risk scores were collected at baseline and follow-up. 254 consecutive patients with PAH retrospectively enrolled in a German reference center served as a validation cohort. RESULTS: A low-risk status at a median of 3.7 years (interquartile range, 1.2-6.8) follow-up was significantly associated with each unit (0.1 mm/mm Hg) increase in TAPSE/sPAP under targeted therapies (European Society of Cardiology/European Respiratory Society score: odds ratio, 1.78; P

• Badagliacca, R.
• Tello, K.
• D'Alto, M.
• Ghio, S.
• Argiento, P.
• Brunetti, N. D.
• Casamassima, V.
• Casu, G.
• Cedrone, N.
• Confalonieri, M.
• Corda, M.
• Correale, M.
• D'Agostino, C.
• De Michele, L.
• Filomena, D.
• Galgano, G.
• Greco, A.
• Lombardi, C.
• Madonna, R.
• Manzi, G.
• Mercurio, V.
• Mihai, A.
• Mulè, M.
• Paciocco, G.
• Papa, S.
• Rako, Z.
• Recchioni, T.
• Richte, M.
• Romaniello, A.
• Romeo, E.
• Scelsi, L.
• Stolfo, D.
• Vitulo, P.
• Yogeswaran, A.
• Naeije, R.
• Benza, R.
• Vizza, C. D.