Background
Although ventriculoarterial coupling is associated with better survival in pulmonary
arterial hypertension (PAH), existing PAH risk assessment method has not considered
echocardiographic criteria of right ventricular to pulmonary artery coupling. We aimed
to test the prognostic value of the echocardiographic tricuspid annular plane systolic
excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio for noninvasive PAH
risk assessment.
Methods
We retrospectively studied a cohort of 659 incident PAH patients from 4 independent
French PH centers (training cohort: n = 306, validation cohort n = 353) who underwent follow-up TAPSE/sPAP measurement in addition to previously validated
noninvasive risk stratification variables. The primary composite outcome was 3-year
all-cause mortality or lung transplantation from re-evaluation.
Results
Mean age was 55 ± 17 years-old with a majority of female (66%). The three main PAH
causes were connective tissue disease (26%), idiopathic (24%) and porto-pulmonary
(19%). The primary composite outcome occurred in 71 (23%) patients. Multivariable
Cox regression analysis retained 3 noninvasive low-risk criteria as associated with
the primary composite outcome: NYHA I-II (p = 0.001), NTproBNP <300 ng/L or BNP <50 ng/L (p = 0.004), and TAPSE/sPAP >0.33 mm/mmHg (p = 0.004). The more the low-risk criteria achieved at follow-up, the better the event-free
survival both in the training and validation cohort (log-rank p < 0.001). In the training cohort, the c-index for these 3 criteria, for COMPERA 2.0
and for the noninvasive French Pulmonary Hypertension Network method were 0.75, 95%CI(0.70-0.82),
0.72 95%CI(0.66-0.75), 0.71 95%CI(0.62-0.73), respectively.
Conclusion
The 3 following dichotomized low-risk criteria: TAPSE/sPAP >0.33 mm/mmHg, NYHA I-II
and NTproBNP <300 ng/L or BNP <50 ng/L allow to identify low-risk PAH patients at
follow-up.
KEYWORDS
Abbreviations:
6MWD (6-minute walking distance), BNP (brain natriuretic peptide), ERS (European Respiratory Society), ESC (European Society of Cardiology), FPHN (French Pulmonary Hypertension Network), mPAP (mean pulmonary artery pressure), NTproBNP (N-Terminal pro-brain natriuretic peptide), NYHA FC (New York Heart Association functional class), PAH (pulmonary arterial hypertension), PVR (pulmonary vascular resistance), RV (right ventricle), RV-PA (right ventricular - pulmonary artery), sPAP (systolic pulmonary artery pressure), TAPSE (tricuspid annular plane systolic excursion), TTE (transthoracic echocardiography)To read this article in full you will need to make a payment
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References
- Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: an update.Eur Respir J. 2019; 53
- 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119
- Treatment of pulmonary arterial hypertension.N Engl J Med. 2004; 351: 1425-1436
- Risk stratification and medical therapy of pulmonary arterial hypertension.Eur Respir J. 2019; 53
- Assessing risk in pulmonary arterial hypertension: what we know, what we don't.Eur Respir J. 2017; 50
- Survival in patients with primary pulmonary hypertension. Results from a national prospective registry.Ann Intern Med. 1991; 115: 343-349
- Patients with pulmonary arterial hypertension with and without cardiovascular risk factors: results from the AMBITION trial.J Heart Lung Transplant. 2019; 38: 1286-1295
- Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry.J Heart Lung Transplant. 2020; 39: 1435-1444
- Clinical implications of idiopathic pulmonary arterial hypertension phenotypes defined by cluster analysis.J Heart Lung Transplant. 2020; 39: 310-320
- Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 501700889
- Development and validation of an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, for use in patients with pulmonary arterial hypertension.Chest. 2021; 159: 337-346
- COMPERA 2.0: a refined 4-strata risk assessment model for pulmonary arterial hypertension.Eur Respir J. 2022; 602102311https://doi.org/10.1183/13993003.02311-2021
- Invasive right ventricular pressure-volume analysis: basic principles, clinical applications, and practical recommendations.Circ Heart Fail. 2022; 15e009101
- Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension.Circ Cardiovasc Imaging. 2019; 12e009047
- Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension.Int J Cardiol. 2018; 266: 229-235
- Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis.Am J Physiol Heart Circ Physiol. 2013; 305: H1373-H1381
- RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes.JACC Cardiovasc Imaging. 2017; 10: 1211-1221
- Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction.Eur J Heart Fail. 2017; 19: 1664-1671
- Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs post-capillary pulmonary hypertension.Eur Heart J Cardiovasc Imaging. 2018; 19: 425-432
- 2018 ESC/ESH Guidelines for the management of arterial hypertension.Eur Heart J. 2018; 39: 3021-3104
- ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).Eur Heart J. 2013; 34: 3035-3087
- KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD).Kidney Int Suppl. 2017; 7: 1-59
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.PLoS Med. 2007; 4: e296
- Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23 (quiz 786–8): 685-713
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.Eur Heart J Cardiovasc Imaging. 2015; 16: 233-270
- Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model.Eur Respir J. 2017; 501700740https://doi.org/10.1183/13993003.00740-2017
- The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension.Chest. 2012; 141: 354-362
- Predicting survival in pulmonary arterial hypertension in the UK.Eur Respir J. 2012; 40: 604-611
- A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.Eur Heart J. 2018; 39 (14): 4175-4181
- Validation of the pulmonary hypertension connection equation for survival prediction in pulmonary arterial hypertension.Chest. 2012; 141: 642-650
- Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337
- Risk assessment in pulmonary arterial hypertension.Eur Respir J. 2018; 51
- Six-minute walk distance target in elderly patients with idiopathic pulmonary arterial hypertension - consideration of predicted values.Int J Clin Pract. 2014; 68: 543-550
- Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis.Chest. 2013; 144: 169-176
- Pulmonary arterial hypertension in France: results from a national registry.Am J Respir Crit Care Med. 2006; 173: 1023-1030
- Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry.Int J Cardiol. 2013; 168: 871-880
- Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up.Respir Res. 2020; ([Internet][cited 2021 Jan 22]. Available from:): 21
- The relationship between the right ventricle and its load in pulmonary hypertension.J Am Coll Cardiol. 2017; 69: 236-243
- Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT).Eur Heart J. 2009; 30: 2493-2537
- Assessment of right ventricular function using two-dimensional echocardiography.Am Heart J. 1984; 107: 526-531
- The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance.J Am Soc Echocardiogr. 2004; 17: 443-447
- Tricuspid annular displacement predicts survival in pulmonary hypertension.Am J Respir Crit Care Med. 2006; 174: 1034-1041
- Right ventricular-pulmonary arterial coupling in patients with HF secondary MR: analysis from the COAPT trial.JACC Cardiovasc Interv. 2021; 14: 2231-2242
- Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair.J Am Coll Cardiol. 2022; 79: 448-461
- A simple echocardiographic estimate of right ventricular-arterial coupling to assess severity and outcome in pulmonary hypertension on chronic lung disease.Eur Respir J. 2019; 541802435
- Objectifs thérapeutiques dans l'hypertension artérielle pulmonaire.La Presse Médicale. 2010; 39: 1S33-1S40
- Validity of echocardiographic tricuspid regurgitation gradient to screen for new definition of pulmonary hypertension.EClinicalMedicine. 2021; 34100822
- Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study.Heart. 2012; 98: 238-243
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Published online: September 13, 2022
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