A TAPSE/SPAP ratio below 0.4 was independently associated with higher mortality (HR 0.76 per 0.1 increment, p<0.001) in 3,436 patients with functional TR.
Does the TAPSE/SPAP ratio predict mortality in patients with functional tricuspid regurgitation?
A TAPSE/SPAP ratio below 0.4 is a strong, independent predictor of excess mortality in patients with functional tricuspid regurgitation, providing incremental prognostic value over its individual components.
Abstract Background The tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP) ratio (TAPSE/SPAP) is touted as a measure of right ventricular (RV) to pulmonary artery (PA) coupling, but its intrinsic, independent and incremental impact on outcome remains uncertain, particularly across the quantified severity spectrum of tricuspid regurgitation (TR). Methods We enrolled a prospective repository of patients with native TR, in whom TR quantitation using proximal-isovelocity-surface-area (PISA), SPAP and TAPSE, were all prospectively measured between 09/2003 and 04/2023. We included only patients with functional TR, without congenital or organic heart disease and without indwelling catheter/lead. The primary outcome was mortality under medical management. Results A total of 3,436 patients (median age 77 years, 57.6% female, median effective-regurgitant-orifice-area 39 mm2) were included. The median TAPSE/SPAP ratio was 0.36 (interquartile-range 0.26-0.51). Over a mean follow-up period of 2.4±2.8 years, 854 (24.9%) patients died. Spline regression, adjusted for age, sex, left ventricular ejection fraction, EROA, comorbidity index, and heart failure severity (TriScore), demonstrated that a TAPSE/SPAP remain linked to mortality, with ratio below 0.4 significantly associated with excess mortality risk (Figure). Multivariable models confirmed that higher TAPSE/SPAP ratio remained independently inversely associated with mortality (adjusted-hazard-ratio 0.76 0.72-0.80 per 0.1 increment, p0.001). Furthermore TAPSE/SPAP ratio provided incremental and independent prognostic value above and beyond the individual values of TAPSE or SPAP (p0.001) and threshold for excess mortality remained consistently at 0.4, irrespective of quantified TR severity. Conclusion The TAPSE/SPAP ratio measured prospectively in routine clinical practice, is a strong and independent prognostic indicator in patients with functional TR, that adds to the prognostic value of its components. A TAPSE/SPAP ratio below 0.4 consistently identifies a subgroup at high-risk of mortality under medical management. These data suggest that therapeutic interventions that may impact positively the TAPSE/SPAP ratio should be tested in patients with functional TR.Mortality risk across TAPSE/SPAP ratio
Tsaban et al. (2025) studied this question. A TAPSE/SPAP ratio below 0.4 was independently associated with higher mortality (HR 0.76 per 0.1 increment, p<0.001) in 3,436 patients with functional TR.