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Prognostic value of TAPSE/sPAP in pulmonary arterial hypertension: a systematic review and meta-analysis
Qin Luo1, Sicong Li1, Zhihua Huang1
1Center for Respiratory and Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Objectives:
Tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) is a simple and validated right ventricle-pulmonary artery (RV-PA) coupling parameter in pulmonary arterial hypertension (PAH). Its prognostic significance for clinical outcomes, however, remains uncertain. This study aimed to evaluate the association between TAPSE/sPAP and key clinical outcomes in PAH.
Methods:
Medline, Embase, and Cochrane Library were searched from inception to 4 March 2025. Cohort studies evaluating associations between TAPSE/sPAP and clinical outcomes in PAH patients were included. Primary outcome was the composite endpoints of all-cause mortality, lung transplantation after re-evaluation, or clinical worsening. Secondary outcomes included individual components of the primary endpoint, time to clinical worsening (TTCW), and ratio of end-systolic elastance to arterial elastance (Ees/Ea). Hazard ratios (HR) with 95% confidence intervals (CIs) were pooled using a fixed-effect model.
Results:
Fourteen studies were included. Higher baseline TAPSE/sPAP was significantly associated with a lower risk of composite endpoints (dichotomous HR = 0.49; continuous HR = 0.93), reduced all-cause mortality (dichotomous HR = 0.49; continuous HR = 0.94) and lower risk of clinical worsening (dichotomous HR = 0.36; continuous HR = 0.00). Follow-up TAPSE/sPAP was also inversely associated with the composite outcome (dichotomous HR = 0.43). No consistent association was observed between TAPSE/sPAP and Ees/Ea.
Conclusion:
TAPSE/sPAP is a strong prognostic marker in PAH, significantly associated with lower risk of composite endpoints, all-cause mortality, and clinical worsening. Follow-up TAPSE/sPAP also predicts outcomes, though its evidence for mortality and worsening remains limited and requires further study.
