TTE-derived TAPSE/PASP ratio effectively stratified the risk of clinical worsening in PAH patients (HR 34.8, p=0.002 for high risk), demonstrating superior prognostic performance over RHC.
Observational (n=90)
Does the TAPSE/PASP ratio measured by TTE provide better prognostic value for clinical worsening than when measured by RHC in patients with pulmonary arterial hypertension?
TTE-derived TAPSE/PASP ratio provides superior risk stratification for clinical worsening in PAH compared to RHC-derived measurements, supporting its use as a non-invasive prognostic tool.
Effect estimate: HR 34.8 (for high risk)
p-value: p=0.002
Background/Objectives: Ventricular-arterial (VA) coupling, assessed via the TAPSE/PASP ratio, is a well-established prognostic marker in pulmonary arterial hypertension (PAH). However, transthoracic echocardiography (TTE) often fails to estimate the pulmonary artery systolic pressure (PASP). This study evaluated the prognostic value of TAPSE/PASP when PSAP was obtained both via TEE and RHC and their correlation. Methods: A prospective registry included 90 PAH patients (April 2021–May 2024). TTE and RHC were performed according to clinical guidelines. The correlation and agreement between both techniques were assessed using Spearman’s rank correlation and a Bland–Altman analysis. The prognostic utility of TAPSE/PASP for clinical worsening (CW) (death or lung transplantation) was evaluated using Cox models, Harrell’s c-statistics, and ROC curve analysis. Results: The median interval between TTE and RHC was 1.5 days (range −3 to +43). TAPSE/PASP showed a strong correlation between both techniques (rho = 0.74, p < 0.001), though TTE slightly overestimated values due to PASP underestimation. The PASP correlation was moderate (rho = 0.56, p < 0.001). CW occurred in 17.8% of patients. According to cut-off points established based on ESC/ERS guidelines, VA coupling via TTE effectively stratified the risk of CW (HR 7.0, p = 0.076 and HR 34.8, p = 0.002 for intermediate and high risk, respectively), whereas VA coupling with PASP measured via RHC showed no association with CW. TAPSE/PASP based on TTE demonstrated superior prognostic performance (C-index = 0.81) over RHC-derived parameters (C-index = 0.58). Conclusions: The TAPSE/PASP ratio showed a strong correlation between TTE and RHC. However, while RHC remains the gold standard for hemodynamic assessments, echocardiographic measurements demonstrated superior performance in risk stratification, supporting its role as a valuable non-invasive tool in PAH.
Gutiérrez et al. (Fri,) conducted a observational in Pulmonary arterial hypertension (PAH) (n=90). TAPSE/PASP ratio measured by transthoracic echocardiography (TTE) vs. TAPSE/PASP ratio measured by right heart catheterization (RHC) was evaluated on Clinical worsening (death or lung transplantation) (HR 34.8 (for high risk), p=0.002). TTE-derived TAPSE/PASP ratio effectively stratified the risk of clinical worsening in PAH patients (HR 34.8, p=0.002 for high risk), demonstrating superior prognostic performance over RHC.