TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension
Roberto Badagliacca, Khodr Tello, Michele D’Alto, Stefano Ghio, Paola Argiento, Natale Daniele Brunetti, Vito Casamassima, Gavino Casu, Nadia Cedrone, Marco Confalonieri, Marco Corda, Michele Correale, Carlo D’Agostino, Lucrezia De Michele, Domenico Filomena, Giuseppe Galgano, Alessandra Greco, Carlo Lombardi, Rosalinda Madonna, Giovanna Manzi, Valentina Mercurio, Alexandra Mihai, Massimiliano Mulè, Giuseppe Paciocco, Silvia Papa, Zvonimir A. Rako, Tommaso Recchioni, Manuel J. Richter, A. Romaniello, Emanuele Romeo, Laura Scelsi, Davide Stolfo, Patrizio Vitulo, Athiththan Yogeswaran, Robert Naeije, Raymond L. Benza, Carmine Dario Vizza, F Adamo, Carlo Albera, Davide Barbisan, Vincenzo Bellomo, Marta Beretta, Marco Biolo, Federico Biondi, Michela Boromei, Andrea Bonelli, Beatrice Pezzuto, R. Carignola, F. Cassadonte, Maria Alberta Cattabiani, Annalisa Caputo, Vincenzo Antonio Ciconte, Paola Confalonieri, Chiara Cresci, Alessandra Cuomo, Raffaele De Caterina, Elisabetta De Tommasi, Gabriele Di Gesaro, Stefania Farina, Francesco Fedele, Martino Fortunato, Giulia Gagno, Pietro Geri, Daniele Ghiraldin, Daniela Giannazzo, Giorgio Giardina, Hossein-Ardeschir Ghofrani Paolo Golino, Maria Chiara Grimaldi, Ludovico Lanfranchi, Mariangela Lattanzio, Claudio Lunardi, Enrico Maggio, Antonella Mannarini, Lavinia Martino, Pierluigi Merella, Cristina Piccinino, Francesca Rampini, Imma Romanazzi, Francesco Salton, Piermario Scuri, Gianmarco Scoccia, Giorgia Serino, Gianfranco Sinagra, Corrado Tamburino, Lucia Tricarico, Sara Uras
Abstract
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-pulmonary artery (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: ≤0.001). At follow-up, the TAPSE/sPAP ratio increased the prognostic information of each risk stratum of the European Society of Cardiology/European Respiratory Society risk score, except the highest risk stratum, with 0.5 mm/mm Hg, 0.35 mm/mm Hg, and 0.30 mm/mm Hg, from the lowest to the intermediate-high risk score, identified as the best cutoff value. TAPSE/sPAP ratio increased the prognostic information of the REVEAL 2.0 score at follow-up, with 0.35 mm/mm Hg identified as the best cutoff value to discriminate within a score of 5 to 8, with no added value for scores <5 and >8. These results were confirmed in the validation cohort. CONCLUSIONS: Assessment of right ventricular-PA coupling by the TAPSE/sPAP ratio in PAH improves risk assessment scores except in the lowest or most advanced stage of the disease.