Tricuspid Annular Displacement Predicts Survival in Pulmonary Hypertension

TLDR

Right ventricular function is a key prognostic determinant in pulmonary hypertension. The study aimed to determine whether tricuspid annular plane systolic excursion (TAPSE) is a useful echo‑derived measure of RV function with prognostic significance in pulmonary hypertension. Patients underwent right heart catheterization followed by transthoracic echocardiography to measure TAPSE, and a TAPSE <1.8 cm correlated with worse RV systolic function, right heart remodeling, and RV/LV disproportion. In pulmonary arterial hypertension, a TAPSE ≥1.8 cm was associated with markedly better 1‑ and 2‑year survival and a 5.7‑fold lower risk of death, while each 1‑mm decrease in TAPSE increased mortality risk by 17%.

Abstract

Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition.To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension.We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement.In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status.TAPSE powerfully reflects RV function and prognosis in PAH.