TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension.

Area of Science:

• Cardiology
• Pulmonary Medicine
• Echocardiography

Background:

• Right ventricular (RV) function is crucial for outcomes in pulmonary arterial hypertension (PAH).
• RV-PA coupling, assessed by TAPSE/sPAP, may refine risk stratification.

Purpose of the Study:

• To evaluate if the TAPSE/sPAP ratio improves risk assessment for survival prediction in PAH patients on targeted therapies.

Main Methods:

• Prospective enrollment of 677 PAH patients across 11 Italian centers.
• Collection of baseline and follow-up clinical, echocardiographic, and right heart catheterization data.
• Comparison of European Society of Cardiology/European Respiratory Society and REVEAL 2.0 risk scores with and without the TAPSE/sPAP ratio, validated in a German cohort.

Main Results:

• Increased TAPSE/sPAP ratio correlated with low-risk status at long-term follow-up (OR 1.78 for ESC/ERS, OR 1.43 for REVEAL 2.0).
• TAPSE/sPAP ratio enhanced prognostic information for both risk scores, especially in intermediate-risk strata (cutoffs 0.5, 0.35, 0.30 mm/mmHg for ESC/ERS; 0.35 mm/mmHg for REVEAL 2.0).
• Findings were confirmed in a retrospective German validation cohort.

Conclusions:

• The TAPSE/sPAP ratio improves risk stratification in PAH patients.
• This ratio adds prognostic value to existing risk scores, except in the very low or very high disease stages.