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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Interest of TAPSE/sPAP ratio for noninvasive pulmonary arterial hypertension risk assessment

  • Author Footnotes
    # Early Career Researcher.
    Charles Fauvel
    Footnotes
    # Early Career Researcher.
    Affiliations
    Division of Cardiovascular medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio

    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    INSERM EnVI U1096, Université de Rouen, France
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  • Olivier Raitiere
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
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  • Athénaïs Boucly
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • Pascal De Groote
    Affiliations
    Service de Cardiologie, Université de Lille, CHU Lille, Institut Pasteur de Lille, Inserm U1167, Lille, France
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  • Sébastien Renard
    Affiliations
    Service de Cardiologie, Centre Régional de Compétences de l'Hypertension Pulmonaire, Hôpital La Timone, Marseille, France
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  • Jeanne Bertona
    Affiliations
    Service de Cardiologie, Centre Régional de Compétences de l'Hypertension Pulmonaire, Hôpital La Timone, Marseille, France
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  • Nicolas Lamblin
    Affiliations
    Service de Cardiologie, Université de Lille, CHU Lille, Institut Pasteur de Lille, Inserm U1167, Lille, France
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  • Elise Artaud-Macari
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen University Hospital, Rouen, France

    INSERM EnVI U1096, Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, Rouen, France
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  • Catherine Viacroze
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen University Hospital, Rouen, France

    INSERM EnVI U1096, Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, Rouen, France
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  • Dominique Schleifer
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen University Hospital, Rouen, France

    INSERM EnVI U1096, Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, Rouen, France
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  • Stéphane Dominique
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen University Hospital, Rouen, France

    INSERM EnVI U1096, Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, Rouen, France
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  • Jérémie Pichon
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • Xavier Jais
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • David Montani
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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  • Olivier Sitbon
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • Laurent Savale
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • Marc Humbert
    Affiliations
    Saclay, Faculté de Médecine, Université Paris, Le Kremlin-Bicêtre, France

    Service de de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France

    INSERM EnVI U1096, Le Kremlin Bicêtre, France
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  • Fabrice Bauer
    Correspondence
    Reprint requests: Fabrice Bauer, MD, PhD, Division of Cardiovascular medicine, Centre Hospitalier Universitaire Charles Nicolle, 1 rue de Germont, 76000 ROUEN, France. Telephone: +33-023-288-8232.
    Affiliations
    Centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France

    INSERM EnVI U1096, Université de Rouen, France
    Search for articles by this author
  • Author Footnotes
    # Early Career Researcher.
Published:September 13, 2022DOI:https://doi.org/10.1016/j.healun.2022.09.005

      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)
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