What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with preserved ejection fraction (HFpEF) (n=121). Intervention: TAPSE/PASP ratio <0.46 mm/mmHg vs. TAPSE/PASP ratio ≥0.46 mm/mmHg. Primary outcome: All-cause mortality (HR 5.59, 95% CI 2.02-15.45, p=<0.001).

What does this research mean for the field?

A TAPSE/PASP ratio <0.46 mm/mmHg independently predicts all-cause mortality with an HR of 5.59 in patients with heart failure with preserved ejection fraction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to assess the prognostic value of the TAPSE/PASP ratio as an indicator of mortality risk in patients with heart failure with preserved ejection fraction.

February 2, 2026

Right ventriculo-arterial coupling - independent predictor of all-cause long-term mortality in heart failure with preserved ejection fraction

Q: What are the key findings of this study?

A TAPSE/PASP ratio <0.46 mm/mmHg was an independent predictor of all-cause mortality in patients with HFpEF (HR 5.59; 95% CI 2.02-15.45; p<0.001).

Q: What does this research mean for the field?

A TAPSE/PASP ratio <0.46 mm/mmHg independently predicts all-cause mortality with an HR of 5.59 in patients with heart failure with preserved ejection fraction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This research aims to assess the prognostic value of the TAPSE/PASP ratio as an indicator of mortality risk in patients with heart failure with preserved ejection fraction.

Key Result

A TAPSE/PASP ratio <0.46 mm/mmHg was an independent predictor of all-cause mortality in patients with HFpEF (HR 5.59; 95% CI 2.02-15.45; p<0.001).

Key Points

This research aims to assess the prognostic value of the TAPSE/PASP ratio as an indicator of mortality risk in patients with heart failure with preserved ejection fraction.
Conducted a retrospective cohort study
Included adult patients with HFpEF admitted from January 2019 to December 2020
Assessed all-cause mortality with a follow-up of 4 years
Used ROC analysis to determine predictive values and performance of TAPSE/PASP
Excluded certain comorbidities and circumstances impacting data.
Long-term all-cause mortality was 29.26% among the studied cohort
TAPSE/PASP ratio below 0.46 mm/mmHg identified as a strong mortality predictor (HR 5.59)
Model including TAPSE/PASP demonstrated 78% predictive power
ROC AUC for TAPSE/PASP was 0.76, indicating substantial association with mortality

Study Design

Type

Cohort (n=121)

Multicenter

Structured PICO

Does right ventriculo-arterial uncoupling (TAPSE/PASP <0.46 mm/mmHg) predict long-term all-cause mortality in patients with HFpEF?

Population

121 adult patients with HFpEF, excluding those with acute coronary syndrome or pulmonary embolism, followed for a mean of 4 years.

Exposure

Right ventriculo-arterial uncoupling defined by echocardiographic TAPSE/PASP ratio <0.46 mm/mmHg

Comparator

TAPSE/PASP ratio ≥0.46 mm/mmHg

Outcome

All-cause mortality at mean 4 years follow-uphard clinical

A TAPSE/PASP ratio below 0.46 mm/mmHg is a strong, independent echocardiographic predictor of long-term all-cause mortality in patients with HFpEF.

Main Result

Hazard Ratio: 5.59 (95% CI 2.02–15.45)

p-value: p=<0.001

Abstract

Abstract Introduction The interdependence between the right ventricular (RV) systolic force and the RV afterload defines the RV-pulmonary artery coupling (RVPAC). The echocardiographically derived ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) has been proposed as a noninvasive surrogate method to assess RV-PA coupling (RVPAC) and has been reported as an independent prognostic marker in heart failure (HF) with reduced ejection fraction (HFrEF). Although elevated PASP is a common complication in HF with preserved ejection fraction (HFpEF), however limited data exist on the predictive value of RV-PA uncoupling in this population. Purpose To evaluate the prognostic role of the TAPSE/PASP ratio as a surrogate marker of RV-PA uncoupling in patients with HFpEF. Methods We conducted a retrospective cohort study including adult patients with HFpEF consecutively admitted to our cardiology department between January 2019 and December 2020. We excluded cases with acute coronary syndrome, pulmonary embolism, inflammatory bowel disease, autoimmune disorders, repeated admissions of the same patient, in-hospital death, and absence of necessary echocardiographic data from the index admission. All-cause mortality was assessed in October 2024, with a mean follow-up duration of 4 years. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values, sensitivity (Se), and specificity (Sp), based on the Youden index. Results Our study sample included 121 HFpEF patients (mean age 72.21±9.68 years, 61.78% female). Long-term all-cause mortality was 29.26%. The mean TAPSE/PASP ratio was 0.65±0.32 mm/mmHg. ROC analysis showed significant associations with all-cause mortality for: TAPSE/PASP (AUC 0.76, 95% CI 0.68–0.83, cut-off ≤0.46, Se 69.44%, Sp 80.23%, p0.001), PASP (AUC 0.77, 95% CI 0.69–0.84, cut-off 39 mmHg, Se 66.67%, Sp 80.23%, p0.001), TAPSE (AUC 0.64, 95% CI 0.55–0.72, cut-off ≤16 mm, Se 36.11%, Sp 91.86%, p=0.016), NT-proBNP (AUC 0.77, 95% CI 0.68–0.87, p0.001) In multivariate analysis, TAPSE/PASP 0.46 mm/mmHg (HR 5.59, 95% CI 2.02–15.45, p0.001) was an independent predictor of mortality, along with Log10NT-proBNP (HR 9.64, 95% CI 2.46–37.66, p=0.001) and malignancies (HR 13.27, 95% CI 2.29–76.61, p=0.004), outperforming PASP 39 mmHg and TAPSE ≤16 mm. The mortality prediction model including these parameters demonstrated an overall predictive power of 78%, with AUC 0.85 (95% CI 0.78–0.92, p0.001). Kaplan-Meier analysis showed significant differences of mortality and duration of survival between the two groups defined by TAPSE/PASP 0.46 mm/mmHg (Image). Conclusion Right ventricular-pulmonary artery uncoupling, quantified in our cohort by a TAPSE/PASP ratio below 0.46 mm/mmHg, was an independent predictor of all-cause mortality in patients with HFpEF. This parameter outperformed individual assessments of PASP and TAPSE in mortality risk stratification.

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