ERS Respiratory Channel

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Abstract

Aims

TAPSE/sPAP-ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling. It has been related to outcome in patients with pulmonary hypertension(PH). The relevance of RV-PA coupling in mild-or exercise PH(EPH) is unknown.

Methods

Patients with risk for PH and mean pulmonary arterial pressure (mPAP)<25mmHg who underwent echocardiography and invasive resting-and exercise right heart catheterization were analyzed. PH was defined by mPAP>20mmHg, EPH by mPAP/cardiac-output(CO)-slope>3WU. Multivariate COX-regression-analysis and Tree-CART-analysis were used to identify age- and sex independent prognostic cut-offs for TAPSE/sPAP-ratio.

Results

237 patients (male:82; age:64(IQR:54-73)yrs, TAPSE/sPAP-ratio: 0.75±0.19mm/mmHg) were included. 90 patients were diagnosed with mild PH and 202 with EPH. During follow-up-time of 5.25(IQR:2.4-8.7)yrs 36 patients died. TAPSE/sPAP-ratio turned out as age-and sex independent predictor of mortality (HR 0.088[95%CI:0.013-0.617], p=0.014). Tree-CART-analysis revealed a prognostic cut-off at a TAPSE/SPAP-ratio<0.59mm/mmHg (HR 2.870[95%CI: 1.378-5.977], p=0.005). Patients with TAPSE/SPAP above vs. below 0.59mm/mmHg showed significant differences in NTproBNP (109pg/ml [IQR:56-274] vs. 318pg/ml[IQR:144-989], p<0.001), mPAP/CO-slope (4.6WU[IQR:3.2-7.7] vs. 10.1WU[IQR:6.3-15.6], p<0.001), 6MWD (429±102m vs. 387±95m, p=0.002) and CI (2.7L/min/m2[IQR:2.3-3.2] vs. 2.4L/min/m2 [IQR:2.0-2.8], p<0.001).

Conclusion

TAPSE/sPAP-ratio appears as age-and sex independent predictor of all-cause mortality in patients with mild-or exercise-PH. Moreover, TAPSE/sPAP-ratio<0.59mm/mmHg is strongly associated with pulmonary hemodynamics and physical capacity.

Abstract

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