TAPSE is a valid surrogate for RV–PA coupling in PH due to HFREF, showing a strong correlation with Ees/Ea (r = 0.77) without improving prognostic assessment when ratioed with PASP.
Does the echocardiographic TAPSE/PASP ratio accurately reflect invasive RV-PA coupling and predict survival in patients with HFrEF and secondary PH?
TAPSE alone is a reliable and valid surrogate for invasive RV-PA coupling in HFrEF with secondary PH, and adding PASP to create a ratio does not significantly improve prognostic or coupling assessment.
Absolute Event Rate: 0% vs 0%
Abstract Aims The aim of this study was to validate the tricuspid annular plane systolic excursion/systolic pulmonary artery (PA) pressure (TAPSE/PASP) ratio with the invasive pressure–volume (PV) loop-derived end-systolic right ventricular (RV) elastance/PA elastance (Ees/Ea) ratio in patients with heart failure with reduced ejection fraction (HFREF) and secondary pulmonary hypertension (PH). Methods and results The relationship of TAPSE and TAPSE/PASP with RV-PV loop (single-beat) -derived contractility Ees, afterload Ea, and Ees/Ea was assessed in 110 patients with HFREF with and without secondary PH. The results were compared with other surrogate parameters such as the fractional area change/PASP ratio. The association of the surrogates with all-cause mortality was evaluated. In patients with PH (n = 74, 67%), TAPSE significantly correlated with Ees (r = 0. 356), inverse with Ea (r = −0. 514) but was most closely associated with Ees/Ea (r = 0. 77). Placing TAPSE in a ratio with PASP slightly reduced the relationship to Ees/Ea (r = 0. 71) but was more closely related to the parameters of PA vascular load, diastolic RV function, and RV energetics. The area under the curve of TAPSE/PASP and TAPSE for discriminating overall survival in receiver operating characteristic analysis was not different (P = 0. 78. Prognostic relevant cut-offs were 17 mm for TAPSE and 0. 38 mm/mmHg for TAPSE/PASP. Both parameters in multivariate cox regression remained independently prognostically relevant. Conclusion TAPSE is an easily and reliably obtainable and valid surrogate parameter for RV–PA coupling in PH due to HFREF. Putting TAPSE into a ratio with PASP did not further improve the coupling information or prognostic assessment. Trial Identifier DRKS—German Clinical Trials Register (DRKS00011133; https: //www. drks. de/drksweb/navigate. do? navigationId=trial. HTML&TRIALID=DRKS00011133).
Schmeißer et al. (Mon,) reported a other. TAPSE is a valid surrogate for RV–PA coupling in PH due to HFREF, showing a strong correlation with Ees/Ea (r = 0.77) without improving prognostic assessment when ratioed with PASP.