Prognostic relevance of TAPSE/sPAP ratio and its association with exercise hemodynamics in patients with normal or mildly elevated resting pulmonary arterial pressure

Teresa John; Alexander Avian; Nikolaus John; Antonia Eger; Vasile Foris; Katarina Zeder; Horst Olschewski; Manuel Richter; Khodr Tello; Gabor Kovacs; Philipp Douschan

doi:10.1016/j.chest.2024.09.013

Prognostic relevance of TAPSE/sPAP ratio and its association with exercise hemodynamics in patients with normal or mildly elevated resting pulmonary arterial pressure

Chest. 2024 Sep 26:S0012-3692(24)05269-3. doi: 10.1016/j.chest.2024.09.013. Online ahead of print.

Authors

Affiliations

¹ Medical University of Graz, Austria, Department of Internal medicine, Division of Pulmonology.
² Medical University of Graz, Austria, Institute for informatics, statistics and documentation; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
³ Medical University of Graz, Austria, Department of Internal medicine, Division of Pulmonology; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
⁴ Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Institute for Lung Health (ILH), Excellence Cluster Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany.
⁵ Medical University of Graz, Austria, Department of Internal medicine, Division of Pulmonology; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,; Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Institute for Lung Health (ILH), Excellence Cluster Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany.

PMID: 39341493
DOI: 10.1016/j.chest.2024.09.013

Abstract

Background: Echocardiographic TAPSE/sPAP ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling. It has been related to outcome in patients with moderate to severe pulmonary hypertension (PH).

Research question: Is RV-PA coupling of prognostic relevance in patients with suspected PH but only normal or mildly elevated mean pulmonary arterial pressure (mPAP) and is it associated with impaired exercise capacity and exercise hemodynamics?

Study design and methods: Patients with mPAP<25mmHg who underwent echocardiography and exercise right heart catheterization in our PH-clinic, were retrospectively analyzed. Mild PH was defined by mPAP 21-24mmHg and exercise PH (EPH) by a mPAP/cardiac-output (CO) slope >3mmHg/L/min. Multivariate analysis was performed to identify independent predictors for clinical worsening, defined by disease-related hospitalization, transplantation, or death.

Results: 237 patients (female: N=155; median age: 64 (IQR 54-73) years, no PH N=147; mild PH N=90; EPH N=202) were included. During the observation time of 63 (IQR:29-104) months, 36 patients died and 126 events of clinical worsening occurred. TAPSE/sPAP ratio turned out as age- and sex independent predictor of mortality (HR 0.09 95% CI: (0.01 - 0.62) p=0.014) and clinical worsening (HR 0.05 95% CI: (0.35-0.78); p=0.002). TAPSE/sPAP was also significantly correlated to 6-minute walk distance (r= 0.33; p<0.001) and exercise hemodynamics (mPAP/CO slope: r_ρ=-0.56, p<0.001). The best multivariate predictive model for clinical worsening in this patient collective consisted of TAPSE/sPAP ratio (HR: 0.71 (0.53-0.95), p=0.021), NT-proBNP (HR 1.15 (0.99-1.34), p=0.065) and 6MWD (HR: 0.998 (0.995-1.00), p=0.042).

Interpretation: In patients with suspected PH but normal or only mildly elevated resting mPAP, TAPSE/sPAP ratio is an independent predictor of outcome. In addition, it is significantly associated with exercise capacity and exercise hemodynamics and may be a helpful tool in the prediction of future clinical worsening of this patient population.

Keywords: Exercise hemodynamics; Exercise pulmonary hypertension; RV-PA coupling; TAPSE/sPAP ratio; mild pulmonary hypertension; prognosis.