TAPSE/sPAP Ratio in Systemic Sclerosis: Evidence From Pulmonary Hypertension and Implications for Early Risk...

Area of Science:

• Cardiology
• Rheumatology
• Pulmonary Medicine

Background:

• Systemic sclerosis (SSc) significantly impacts morbidity and mortality, particularly with cardiopulmonary complications like pulmonary hypertension (PH) and right ventricular (RV) dysfunction.
• RV adaptation to increased pulmonary vascular load is a key prognostic factor in PH, potentially more so than pulmonary pressure alone.

Purpose of the Study:

• To systematically review the clinical relevance of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio in systemic sclerosis patients across various disease stages.
• To synthesize evidence on the association between TAPSE/sPAP and clinical outcomes in SSc, including mortality and disease progression.

Main Methods:

• A systematic literature review was conducted following PRISMA guidelines, searching PubMed/MEDLINE from January 2006 to January 2026.
• Studies evaluating the TAPSE/sPAP ratio in adult SSc patients with or without PH and its association with clinical outcomes were included.
• Data extraction and quality assessment were performed by two independent reviewers, with narrative synthesis due to heterogeneity.

Main Results:

• Five observational studies were included, covering a spectrum of SSc phenotypes from screening cohorts to catheterization-confirmed PH.
• Consistently lower TAPSE/sPAP values were associated with worse clinical outcomes across studies.
• Impaired RV-pulmonary circulation coupling (indicated by lower TAPSE/sPAP) was observed even in some patients without overt PH, suggesting early RV adaptation issues.

Conclusions:

• The TAPSE/sPAP ratio shows promise as an accessible marker for RV adaptation to pulmonary vascular load in SSc.
• Current evidence is limited and observational, with variable threshold values across studies, precluding universal application.
• Further prospective, multicenter studies are essential to establish the role of TAPSE/sPAP in screening, risk stratification, and monitoring pulmonary vascular disease in SSc.