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… Click to show full abstract
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: <0.19 mm/mmHg; middle: 0.19-0.32 mm/mmHg; high: >0.32 mm/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.
               
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