TAPSE/sPAP Ratio Associated with Increased Mortality in Subjects With and Without Cardiovascular Comorbidities- Insights from a Tertiary Center Database

BACKGROUND: Tricuspid-annular-plane-systolic-excursion (TAPSE)- systolic pulmonary artery pressure (sPAP) ratio is an emerging parameter of right-ventricle and pulmonary circulation coupling. OBJECTIVES: To elucidate a TAPSE/sPAP threshold associated with increased mortality in consecutive subjects, with and without cardiovascular comorbidities, undergoing echocardiography in a tertiary referral center. METHODS: We performed a retrospective analysis of consecutive subjects undergoing echocardiography in a single tertiary center between 2011-2021. TAPSE was measured using M-mode and sPAP was calculated by summing tricuspid valve pressure gradient and right atrium pressure. Cut-off values associated with excess mortality were assessed using spline curves in univariate, and multivariate Cox analyses. RESULTS: A total of 17951 subjects were included in the current analysis (47% females; median age: 71 y/o; interquartile range [IQR]: 58-81). Median TAPSE and sPAP were 21 mm (IQR: 18-25) and 31 mmHg (IQR: 26-41), respectively. A TAPSE/sPAP ratio of <0.68 mm/mmHg was associated with excess mortality. In sub-group analysis, among subjects with and without cardiovascular comorbidities, a ratio of <0.53 and <0.79 mm/mmHg, respectively, was associated with excess mortality. In a multivariate model adjusted for baseline and echocardiographic parameters a TAPSE/sPAP ratio <0.68 mm/mmHg was independently associated with increased mortality (adjusted hazard ratio 1.52, 95% confidence interval 1.42-1.63; p < 0.001). CONCLUSION: Excess mortality in consecutive subjects performing echocardiography in a tertiary center is seen at higher TAPSE/sPAP values than previously described. The TAPSE/sPAP cutoff associated with excess mortality is influenced by comorbidities and hospitalization status.