Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension

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.