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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Published online: September 13, 2022
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