Key result
Combining TAPSE/sPAP and RV work efficiency predicts PAH clinical worsening with an AUC of ~0.95.
Why the study?
Pulmonary arterial hypertension leads to right ventricular failure, and the prognostic value of combining the TAPSE/sPAP ratio with right ventricular myocardial work parameters to improve early risk stratification required evaluation.
Does the combination of TAPSE/sPAP ratio and RVGWE improve prognostic prediction of clinical worsening events in patients with pulmonary arterial hypertension?
Observational (n=43)
No
Does the combination of TAPSE/sPAP ratio and RVGWE improve prognostic prediction of clinical worsening events in patients with pulmonary arterial hypertension?
Effect estimate: AUC 0.949
p-value: p=<0.001
Combining the load-dependent TAPSE/sPAP ratio with load-independent right ventricular global work efficiency (RVGWE) provides a highly discriminative non-invasive tool for predicting early clinical worsening in PAH patients.
Objective: Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) hypertrophy and failure. This study aims to evaluate the prognostic value of combining the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with right ventricular myocardial work (RVMW) parameters in patients with PAH, to improve early risk stratification. Methods: A total of 43 PAH patients diagnosed via right heart catheterization were enrolled. Echocardiography-derived TAPSE/sPAP ratio and RVMW parameters, including right ventricular global work efficiency (RVGWE), global work index (RVGWI), global constructive work (RVGCW), and global wasted work (RVGWW), were measured. Clinical worsening events were recorded during a median 515-day follow-up. Statistical analyses included correlation tests, Firth penalized logistic regression, receiver operating characteristic (ROC) curves, and Kaplan–Meier survival analysis. Results: The TAPSE/sPAP ratio correlated negatively with RVGCW (r = -0.346, p = 0.023) and RVGWW (r = -0.417, p = 0.005), but not with RVGWE or RVGWI. Clinical worsening events occurred in 25.6% of patients, with significantly lower TAPSE/sPAP ratio (0.16 vs. 0.24 mm/mmHg), RVGWE (72.0% vs. 88.5%), and RVGWI (431.0 vs. 641.0 mmHg%) in the Event group (all p < 0.05). Multivariate Firth penalized logistic regression was used for combining TAPSE/sPAP ratio with RVGWE. ROC analysis demonstrated that the combination of TAPSE/sPAP and RVGWE yielded superior predictive power (AUC = 0.949, p < 0.001) compared to individual parameters. Conclusion: Non-invasive assessment of TAPSE/sPAP ratio and RVGWE provides significant prognostic value in PAH. Their combination enhances early risk prediction, offering a practical tool for clinical management.
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Wang et al. (2026) conducted an observational in Pulmonary arterial hypertension (n=43). Combination of TAPSE/sPAP ratio and RVGWE vs. Individual parameters (TAPSE/sPAP or RVGWE alone) was evaluated on Clinical worsening events (all-cause mortality, hospitalization due to PAH, and addition of new targeted drugs) (AUC 0.949, p=<0.001). The combination of TAPSE/sPAP ratio and right ventricular global work efficiency (RVGWE) demonstrated superior predictive power for clinical worsening events in patients with pulmonary arterial hypertension (AUC = 0.949, p < 0.001).
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