A lower ratio of tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure (TAPSE/PASP) was independently associated with an increased risk of death or lung transplantation (HR 0.917).
Cohort (n=34)
No
Does the TAPSE/PASP ratio predict the composite of death or lung transplantation in patients with severe PAH referred for lung transplant evaluation?
A low TAPSE/PASP ratio (<0.30 mm/mmHg) is a strong independent predictor of death or need for lung transplantation in patients with severe PAH.
Effect estimate: HR 0.917 (95% CI 0.855-0.984)
p-value: p=0.016
Lung transplantation (LT) is the only option for patients with pulmonary arterial hypertension (PAH) refractory to maximal medical therapy. However, some patients referred for LT could survive without LT, and its determinants remain unclear. This study aimed to elucidate prognostic factors of severe PAH at the referral time. We retrospectively analyzed 34 patients referred for LT evaluation. The primary outcome was a composite of death or LT. Over a median follow-up period of 2.56 years, eight patients received LT and eight died. Compared with LT-free survival group, pulmonary arterial systolic pressure (PASP) was higher (p = 0.042), and the ratio of tricuspid annular plane systolic excursion (TAPSE) to PASP (TAPSE/PASP) was lower (p = 0.01) in LT or death group. In receiver operating characteristic analysis, the area under the curve was 0.759 (95% confidence interval 0.589-0.929) for TAPSE/PASP to predict primary outcome, and the optimal cut-off value was 0.30 mm/mmHg (sensitivity 0.875 and specificity 0.667). In a multivariate analysis, TAPSE/PASP was independently associated with death or LT. Kaplan-Meier analysis showed a better LT-free survival in patients with TAPSE/PASP ≧0.30 mm/mmHg than in those with < 0.30 mm/mmHg (p = 0.001). Low-level TAPSE/PASP could be a poor prognostic factor in PAH patients referred for LT evaluation.
Ishii et al. (Tue,) conducted a cohort in Pulmonary arterial hypertension (PAH) (n=34). TAPSE/PASP ratio was evaluated on Composite of death or lung transplantation (HR 0.917, 95% CI 0.855-0.984, p=0.016). A lower ratio of tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure (TAPSE/PASP) was independently associated with an increased risk of death or lung transplantation (HR 0.917).