The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure index: Association with all-cause mortality in patients with moderate or severe tricuspid regurgitation

Abstract

BackgroundIn patients with significant tricuspid regurgitation (TR) the conventional markers for the assessment of right ventricular (RV) systolic function may be less accurate. Tricuspid annular plane systolic excursion (TAPSE) indexed to systolic pulmonary artery pressure (SPAP) (TAPSE/SPAP) may be prognostically useful in pulmonary hypertension and left ventricular dysfunction. Our aim was to explore its use in patients with moderate or severe TR. MethodsA total of 209 patients (72 ± 14 years, 56% women) with moderate (n = 123) or severe (n = 86) TR (primary in 6% and secondary in 94%) were followed up for a median of 80 months (mean 70 ± 33 months). The clinical correlates of TAPSE/SPAP index and association with all-cause mortality were assessed. ResultsThe TAPSE/SPAP index was inversely correlated with all-cause mortality with an optimal threshold of 0.49 mm/mmHg. A low index was found in 139 (68%) patients. In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, left ventricular ejection fraction, right atrium area and mitral valve replacement, low TAPSE/SPAP index was associated with significantly higher hazard ratio of all-cause mortality (HR: 2.07; 95% CI 1.32–3.27, p = .002). Age, coronary artery disease, left ventricular ejection fraction and right atrium area were other independent predictors of all-cause mortality. ConclusionThe TAPSE/SPAP index, reflecting RV systolic function in the longitudinal axis corrected for force generating by the RV is a powerful predictor of all-cause mortality in patients with moderate or severe TR.