Begum Uygur1, Mustafa Yildiz1, Ali Riza Demir1, Serkan Kahraman1, Kadriye Memic Sancar1, Ayfer Uykusavas2, Hicaz Zencirkiran Agus1, Ahmet Guner1, Omer Celik1, Mehmet Ertürk1

1University Of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Cardiology, Istanbul, Turkey
2University Of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Pneumology, Istanbul, Turkey

Keywords: prognosis, pulmonary arterial hypertension, tapse/spap

Abstract

Objectives: Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease in which the risk stratification and the prognostic evaluation play a crucial role. Assessment of RV function is an important part of the follow-up. Tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) is a simple, and readily available echocardiographic parameter which was stated as a prognostic predictor in various cardiac diseases. Herein, our aim was to evaluate the role of TAPSE/sPAP in prediction of long-term prognosis in PAH.

Patients and Methods: Our retrospective study enrolled a total of 41 PAH patients including 25 idiopathic PAH and 16 congenital heart disease associated PAH patients. Comprehensive echocardiographic examination, laboratory examination, 6 minutes walking test and cardiopulmonary exercise test were performed to all patients at the same day. Primary endpoint of the study was mortality or hospitalization. The relationship between TAPSE/sPAP and the composite outcomes were evaluated statistically.

Results: During mean 20.2 ± 9.2 months follow-up, nine patients were hospitalized, and three patients died. Median TAPSE/sPAP was 0.26 (0.19-0.40). TAPSE/sPAP (P = 0.003; HR (95% CI): 10.928 (2.240-53.316)) was found to be an independent predictor of composite outcomes in PAH patients. TAPSE/sPAP < 0.23 predicted mortality and hospitalization with a sensitivity of 80.0%, specificity of 71.4% (Area under curve (AUC): 0.768; 95% CI: 0.596-0.939; P = 0.013). The Kaplan-Meier cumulative survival curve revealed that as TAPSE/sPAP decreased, mortality and hospitalization rates increased significantly. Moreover, NT-proBNP (P = 0.014; HR (95% CI): 1.001 (1.000-1.001)) was found to be an independent predictor.

Conclusion: TAPSE/sPAP was an independent predictor of long-term prognosis in PAH. TAPSE/sPAP which is a simple, cheap and readily available echocardiographic parameter, might be used as an important prognostic factor in PAH patients.