Khodr Tello1, Jens Axmann1, Hossein A Ghofrani2, Robert Naeije3, Newroz Narcin1, Andreas Rieth4, Werner Seeger1, Henning Gall1, Manuel J Richter5. 1. Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany. 2. Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany; Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany; Department of Medicine, Imperial College London, London, UK. 3. Erasme University Hospital, Brussels, Belgium. 4. Department of Cardiology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany. 5. Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany. Electronic address: manuel.richter@innere.med.uni-giessen.de.
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.
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.
Authors: Andrea Salzano; Roberta D'Assante; Eduardo Bossone; Alberto M Marra; Antonio Cittadini; Massimo Iacoviello; Vincenzo Triggiani; Giuseppe Rengo; Francesco Cacciatore; Ciro Maiello; Giuseppe Limongelli; Daniele Masarone; Angela Sciacqua; Pasquale Perrone Filardi; Antonio Mancini; Maurizio Volterrani; Olga Vriz; Roberto Castello; Andrea Passantino; Michela Campo; Pietro A Modesti; Alfredo De Giorgi; Michele Arcopinto; Paola Gargiulo; Maria Perticone; Annamaria Colao; Salvatore Milano; Agnese Garavaglia; Raffaele Napoli; Toru Suzuki Journal: Cardiovasc Diabetol Date: 2022-06-16 Impact factor: 8.949
Authors: Juan C Grignola; Enric Domingo; Manuel López-Meseguer; Pedro Trujillo; Carlos Bravo; Santiago Pérez-Hoyos; Antonio Roman Journal: Front Physiol Date: 2021-05-03 Impact factor: 4.566
Authors: Andreas J Rieth; Manuel J Richter; Khodr Tello; Henning Gall; Hossein A Ghofrani; Stefan Guth; Christoph B Wiedenroth; Werner Seeger; Steffen D Kriechbaum; Veselin Mitrovic; P Christian Schulze; Christian W Hamm Journal: Clin Res Cardiol Date: 2021-06-10 Impact factor: 5.460