Clinical and Invasive Hemodynamic Correlates of the TAPSE/sPAP Ratio in Pulmonary Hypertension

BACKGROUND: Right ventricular (RV) adaptation to increased pulmonary afterload is a major determinant of prognosis in pulmonary hypertension (PH), yet comprehensive validation of simple noninvasive markers against invasive hemodynamic parameters remains limited. We investigated whether the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio reflects the clinical, echocardiographic, and invasive hemodynamic spectrum of PH. METHODS: We retrospectively analyzed 209 consecutive patients with right heart catheterization-confirmed PH who underwent comprehensive clinical assessment, transthoracic echocardiography, and invasive hemodynamic evaluation between 2016 and 2024. Patients were stratified into quartiles according to the TAPSE/sPAP ratio, and clinical, laboratory, echocardiographic, and hemodynamic characteristics were compared. RESULTS: The mean age was 58.8 ± 16.5 years, and 61% of patients were female. Lower TAPSE/sPAP ratios were associated with older age, higher NT-proBNP and serum uric acid levels, and lower estimated glomerular filtration rate (all p < 0.05). Decreasing TAPSE/sPAP ratios were also associated with larger right atrial and right ventricular dimensions, lower TAPSE, and higher tricuspid regurgitation velocity and estimated sPAP (all p < 0.001). Invasive hemodynamic assessment demonstrated progressively higher right ventricular systolic pressure, mean pulmonary artery pressure, and pulmonary vascular resistance (all p < 0.001), whereas mixed venous oxygen saturation increased across quartiles (p = 0.036). CONCLUSIONS: The TAPSE/sPAP ratio is a practical, noninvasive marker that closely reflects right ventricular remodeling and invasive hemodynamic impairment in pulmonary hypertension. Lower TAPSE/sPAP ratios identify patients with more advanced RV-pulmonary arterial uncoupling and may improve bedside hemodynamic risk stratification.