Pulmonary Artery Pressure Ratio Research Articles

Clinical and echocardiographic characterization of patients hospitalized for severe tricuspid valve regurgitation: a single tertiary-care center experience with 2-year follow-up.

Tricuspid regurgitation (TR) is a common acquired valvular heart disease. Recently, new transcatheter treatment options for severe TR have emerged that could change management of this condition, which warrants better characterization of this specific patient group. The aim of the study was to describe the clinical and echocardiographic characteristics of patients with severe TR and to evaluate their short- and mid‑term prognosis. This retrospective, observational, single‑center study enrolled consecutive patients with severe TR hospitalized between January 2016 and September 2021 in the Department of Cardiology, Medical University of Warsaw, Poland. The severity of heart failure (HF) was evaluated using the New York Heart Association classification. Echocardiographic assessment was performed by an experienced sonographer. EuroSCORE II and TRI‑SCORE models were computed for each patient, and 12- and 24‑month clinical outcomes were reported. The study comprised 172 patients (93 women [54.1%]) at a mean (SD) age of 76.4 (10.5) years. The most common comorbidities included: atrial fibrillation (84.9%), hypertension (68%), chronic kidney disease (54.1%), coronary artery disease (45.3%), and diabetes mellitus (30.9%). The median (interquartile range) EuroSCORE II and TRI‑SCORE values were 4.68% (2.88%-8.05%) and 14% (5%-34%), respectively. The median follow‑up was 24 (8.5-41) months. The overall mortality was 29.7% at 1 year and 47.3% at 2 years. TR grade, tricuspid annular plane systolic excursion (TAPSE) above 17 mm, TAPSE to systolic pulmonary artery pressure ratio below 0.26, and increased right atrial area were significant factors associated with mortality. Patients presenting with severe TR are characterized by a large comorbidity burden and poor prognosis, despite intensive HF management.

Tricuspid Annular Plane Systolic Excursion-to-Systolic Pulmonary Artery Pressure Ratio as a Prognostic Factor in Heart Transplant Patients.

Background and Objectives: Heart transplant is currently the final step in treating patients with heart failure. The success of this procedure is strongly connected to potential complications such as postoperative heart failure, infections, graft rejection, graft vasculopathy, and kidney failure. Thus, identifying potential prognostic factors for patients' outcome is of utmost importance. We investigated the prognostic role of the postoperative ratio between the tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) in patients who underwent heart transplantation in our center. Materials and Methods: The study included 46 adult patients from the Emergency Institute for Cardiovascular Diseases and Transplant of Târgu Mureș, who underwent heart transplant between January 2011 and April 2023. By the use of receiver operating characteristic (ROC) analysis, we determined an optimal cut-off value for TAPSE/sPAP with regard to survival at 6 months. Differences in central tendencies of baseline characteristics in those who had a value lower than the cut-off value of TAPSE/sPAP and those who presented a value above it were investigated using the corresponding parametric or nonparametric tests. Results: A value for TAPSE/sPAP above 0.47 mm/mmHg was associated with 6-month survival (OR: 59.5, CI: 5.7-616.0). No significant differences in central tendencies for baseline characteristics were found between the patients who had a TAPSE/sPAP ratio below the cut-off and those who had a ratio above it. Conclusions: The TAPSE/sPAP ratio might prove to be valuable in the early identification of at-risk heart transplant patients. Further prospective studies with larger cohorts are required for validation.

Multifaced risk factors and clinical impact of a deep Y descent in patients with heart failure irrespective of RV-PA coupling

BackgroundA deep Y descent in the jugular venous pulse (JVP) is associated with diseases such as a decrease in right ventricular (RV) preload reserve. The present study investigated the relationship between RV-pulmonary arterial (PA) coupling and a deep Y descent, examined risk factors for a deep Y descent and clarified whether a deep Y descent was an independent risk factor for cardiac events irrespective of RV-PA coupling in patients with heart failure (HF). MethodsWe enrolled 350 patients with HF who underwent echocardiography and JVP examination. A deep Y descent was identified by a deeper ‘Y’ descent than ‘X’ descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, the emergent infusion of loop diuretics, or hospitalization for decompensated HF. Results and ConclusionsA deep Y descent and cardiac events were observed in 129 and 83 patients, respectively. The prevalence of a deep Y descent increased with decreases in the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio. Not only the TAPSE/SPAP ratio (odds ratio,0.756 per0.1 mm/mmHg, 95 %confidence interval [CI], 0.660–0.866, p < 0.001), but also age, atrial fibrillation, and the use of beta-blockers were independent factors for a deep Y descent in multivariate logistic model. Multivariate Cox hazard model demonstrated that a deep Y descent was for cardiac events in patients with HF (Hazard ratio,2.682, 95 %CI, 1.599–4.497, p < 0.001) irrespective of the TAPSE/SPAP ratio. The development of therapeutic strategies based on central venous waveform may be needed for patients with HF.

Right ventricular strain to systolic pulmonary artery pressure ratio in response to treatment of pulmonary arterial hypertension.

The RVFWLS/PASP ratio, a novel surrogate for ventriculoarterial coupling, showed sensitivity to afterload-lowering treatment and the magnitude of change informed on long-term outcomes in PAH https://bit.ly/4cRtREC.

F-2 | Role of mean systemic to pulmonary artery pressure ratio in balloon pulmonary angioplasty and chronic thromboembolic pulmonary hypertension

F-2 | Role of mean systemic to pulmonary artery pressure ratio in balloon pulmonary angioplasty and chronic thromboembolic pulmonary hypertension

Valor pronóstico de la razón desplazamiento sistólico del plano del anillo tricuspídeo/presión arterial pulmonar sistólica en la amiloidosis cardiaca

Introduction and objectivesThe tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/SPAP) ratio is a noninvasive surrogate of right ventricular to pulmonary circulation that has prognostic implications in patients with heart failure (HF) or pulmonary hypertension. Our purpose was to evaluate the prognostic value of the TAPSE/SPAP ratio in patients with cardiac amyloidosis. MethodsWe used the database of the AMIGAL study, a prospective, observational registry of patients with cardiac amyloidosis recruited in 7 hospitals of the Autonomous Community of Galicia, Spain, from January 1, 2018 to October 31, 2022. We selected patients whose baseline TAPSE/SPAP ratio was calculated with transthoracic echocardiography. Long-term survival and survival free of HF hospitalization were assessed by means of 5 different multivariable Cox regression models. Median follow-up was 680 days. ResultsWe studied 233 patients with cardiac amyloidosis, among whom 209 (89.7%) had transthyretin type. The baseline TAPSE/SPAP ratio correlated significantly with clinical outcomes. Depending on the multivariable model considered, the adjusted hazard ratios estimated per 0.1mm/mmHg increase of baseline TAPSE/SPAP ratio ranged from 0.76 to 0.84 for all-cause mortality. Similarly, the ratios for all-cause mortality of HF hospitalization ranged from 0.79 to 0.84. The addition of the baseline TAPSE/SPAP ratio to the predictive model of the United Kingdom National Amyloidosis Centre resulted in an increase in Harrell's c-statistic from 0.662 to 0.705 for all-cause mortality and from 0.668 to 0.707 for all-cause mortality or HF hospitalization. ConclusionsReduced TAPSE/SPAP ratio is an independent adverse prognostic marker in patients with cardiac amyloidosis.

Right ventricular-pulmonary arterial uncoupling and ventricular-secondary mitral regurgitation: Relationship with outcomes in advanced heart failure

BackgroundSecondary mitral regurgitation (MR) is common in heart failure with reduced ejection fraction (HFrEF) and associated with poor outcomes. However, there is little evidence regarding secondary MR in advanced HFrEF. Poor outcomes for MR intervention suggest a need for further risk stratification. ObjectivesWe hypothesized adverse prognosis in right ventricles (RV) less able to compensate for increased pulmonary pressures of post-capillary cause in the context of secondary MR. MethodsPatients were assessed with echocardiography, right heart catheterisation (RHC) and cardiopulmonary exercise testing. Ventricular-secondary MR was identified by echocardiography and categorised mild, moderate, or severe according to guidelines. RV ability to compensate for pulmonary pressure rise was assessed by RV-pulmonary artery (PA) coupling, calculated as ratio of tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) (echocardiography for TAPSE and RHC for SPAP). Primary endpoint was a composite of all-cause mortality, urgent heart transplantation or mechanical circulatory support. Results456 patients with ventricular-secondary MR were followed up for a median of 2.39 years, with 237 reaching a primary endpoint. Severe MR conferred a worse prognosis than mild or moderate (HR 2.6, p<0.001). Right atrial pressure was predictive of survival. RV-PA uncoupling, defined as TAPSE/SPAP below median value of 0.37, was associated with reduced survival across all severities of mitral regurgitation (p<0.001). ConclusionsVentricular-secondary MR is common and severity correlates with adverse prognosis in advanced heart failure. RV-PA uncoupling can improve risk stratification in all grades of MR severity, particularly with PA pressure determined invasively.

The Influence of Preoperative Right Ventricle to Pulmonary Arterial Coupling on Short- and Long-Term Prognosis in Patients Who Underwent Transcatheter Aortic Valve Implantation

The present study evaluated the prognostic significance of right ventricular-pulmonary arterial (RV-PA) coupling, assessed by the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). This retrospective, single-center study involved 403 patients (mean age: 78.2 ± 8.4; 50.9% female). RV-PA coupling was categorized based on the pre-procedural TAPSE/sPAP ratio: severe uncoupling (≤0.32), moderate uncoupling (0.32–0.55), and normal coupling (&gt;0.55). The study primary endpoints were in-hospital mortality and 2-year all-cause mortality. Multivariate logistic regression revealed that the TAPSE/sPAP ratio is an independent predictor of both in-hospital (adjusted OR: 0.61, 95% CI [0.44–0.84], P = .002) and 2-year mortality (adjusted OR: 0.69, 95% CI [0.56–0.85], P = .001). Severe uncoupling was strongly associated with increased 2-year mortality (adjusted OR: 3.92, 95% CI [1.67–9.20], P = .002). Our study establishes a significant association between reduced preoperative TAPSE/sPAP ratios and increased risks of both in-hospital and 2-year all-cause mortality in patients undergoing TAVI for severe AS. These results highlight the prognostic utility of evaluating RV-PA coupling. Incorporating this metric into preoperative risk stratification could potentially refine prognostic accuracy and inform clinical decision-making.

Prognostic Role of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure Ratio for the Identification of Early Clinical Deterioration in Intermediate-High–Risk Pulmonary Embolism Patients

The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate high-risk PE patients. A post-hoc analysis of intermediate-high risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent a transthoracic echocardiography (TTE) at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. Among 422 intermediate high-risk PE patients (mean age 71.2±5.3 years, 238 males), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n=28). Receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-h clinical deterioration (AUC of 0.79 ± 0.1). Sensitivity, specificity, PPV and NPV were 81%, 88.5%, 40.5% and 97.9%, respectively. Multivariate Cox regression analysis showed that a TAPSE/PASP≤0.33 was an independent predictor of 48-h clinical deterioration (HR: 2.06, 95% CI 1.98-2.11, p<0.0001) and 30-day mortality (HR: 2.28, 95% CI: 2.25-2.33, p<0.001). TAPSE/PASP shows promise as a non-invasive prognostic predictor to identify intermediate-high risk PE patients at higher risk of early clinical deterioration and short-term mortality.

Utility of TAPSE/sPAP Ratio in Acute Pulmonary Embolism as Valuable Prognostic Marker as PESI Score

Introduction: The pulmonary embolism severity index (PESI) score is used to determine the risk of mortality and severity of complications in acute pulmonary embolism (APE). Tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio has been recently shown to predict poor 30-day clinical outcome in APE. We aimed to analyze the prognostic value of the TAPSE/sPAP ratio for prediction of 30-day adverse clinical outcomes in APE patients, similar to PESI score. Patients and Methods: This study enrolled 203 retrospectively evaluated patients (female 108, mean age= 57.4 ± 15.5 years) with the diagnosis of APE between 2010 and 2020. All patients underwent transthoracic echocardiography before specific APE treatment. Primary endpoints were 30-day mortality, thrombolytic therapy requirement, mechanical ventilation requirement, mental status deterioration, and persistent hypotension (systolic blood pressure &lt;90 mmHg). The study population was divided into two groups according to the TAPSE/sPAP ratio= 114 patients in group 1 with a low TAPSE/sPAP ratio (&lt;0.494) and 89 patients in group 2 with a high TAPSE/sPAP ratio (&gt;0.494). Results: The incidence of in-hospital mortality (4.4 vs. 0%, p= 0.045], 30-day mortality [n= 8 (7.0%); 0 (0%), p= 0.009] and primary adverse outcomes (35.1 vs. 0%, p&lt; 0.001) were higher in group 1. The TAPSE/sPAP ratio was negatively correlated with PESI (r= -0.716, p&lt; 0.001). In multivariate logistic regression analyses revealed that the TAPSE/sPAP ratio [OR= 0.001, 95C% CI= 0.000-0.476, p= 0.028] was an independent predictor of 30-day mortality in APE. Conclusion: The present study showed that the TAPSE/sPAP ratio may be used in clinical practice for the prediction of short-term adverse outcome risk estimation in APE patients, similar to PESI score.

Comprehensive echocardiographic evaluation in CTEPH: the impact of TAPSE/sPAP and RVOT acceleration time on the diagnostic performance of peak tricuspid regurgitation velocity

Abstract Introduction The hemodynamic definition of pulmonary hypertension (PH) has been updated, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg according to the new 2022 ESC/ERS Guidelines. Peak tricuspid regurgitation velocity (PTRV) remains the key variable for assigning the echocardiographic probability of PH, but a comprehensive echocardiographic evaluation also includes detecting additional signs suggestive of PH. Since the cut-off for PTRV remained the same (&amp;gt;2.8m/s), the potential impact of other echocardiographic variables in the diagnosis of PH according to the new criteria has not been extensively evaluated. Objectives To evaluate the screening power of the standard echocardiographic parameters to detect PH according to the new guidelines and to establish the sensitivity and specificity of adding tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure ratio (TAPSE/sPAP) and right ventricular outflow tract acceleration time (RVOT AT) to PTRV in the diagnosis of PH. Methods Prospective registry of consecutive intermediate-high- and high-risk PE pts submitted to CDT in a single tertiary center. 3 months after the procedure, patients were submitted to a right heart catheterization and echocardiogram to screen chronic thromboembolic pulmonary hypertension (CTEPH). According to new PH criteria, patients were divided in two groups, and echocardiographic parameters were analyzed. ROC curve was performed to evaluate the sensitivity and specificity of each variable. Results 17 pts (60% women, mean age 59 ± 16 years) were included. Among these, 7 pts (41,2%) were diagnosed with pre-capillary PH by RHC at 3 months of follow-up. Among echocardiographic parameters, PTRV (p 0.015), presence of tricuspid regurgitation (0.034) and TAPSE/sPAP (p 0.041) were significantly different between groups. Other parameters did not show significant differences (Fig 1). Regarding PTRV, the cut-off of 2.8 m/s achieved a low sensitivity of 28.6%, although 100% of specificity (AUC 0.643) for the diagnosis of PH. Adding TAPSE/sPAP &amp;lt; 0,55 mm/mmHg (recommended cut-off) to the screening, increased the sensitivity to 42,9% without losing specificity (AUC 0,714). When adding RVOT AT &amp;lt; 105 ms (recommended cut-off) to the analysis, meaning, using three echocardiographic variables combined, it achieved a sensitivity of 85,7%, although the specificity was lower – 80% (AUC 0,829) (Fig 2). Conclusion PTRV and TAPSE/sPAP ratio are the only conventional echocardiographic parameters to be significantly different when comparing patients with and without PH. However, with the recent update in PH criteria, the use of the PTRV recommended cut-off leads to a significant underdiagnosis in our population. Although PTRV did not seem to predict accurately the presence of PH when used alone, when combined with TAPSE/sPAP and RVOT AT, our data suggests a growth in the screening power, without a major loss in specificity.Figure 1Figure 2

Qp/Qs in ostium secundum atrial septal defect mitigates right ventricular dysfunction in patients with secondary pulmonary hypertension

Abstract Background Ostium-secundum atrial septal defect (OS-ASD) can potentially lead to pulmonary hypertension (PH) and associated right ventricle (RV) - pulmonary artery (PA) uncoupling. This, in turn, may eventually result in RV systolic dysfunction. Notwithstanding, whether the characteristics of the OS-ASD could mitigate this relationship is unclear. Purpose To evaluate a potential interaction of the OS-ASD shunt (Qp/Qs ratio) on the relationship with RV–PA coupling and RV systolic function in patients with secondary PH. Methods We designed a cross-sectional study of 63 adult patients with OS-ASD in which we performed a conventional transthoracic echocardiogram using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway). We evaluated the OS-ASD shunt and other echocardiographic parameters, including the tricuspid annular plane systolic excursion (TAPSE), the systolic pulmonary artery pressure (sPAP) ratio and the right ventricular free wall longitudinal strain (RVFWLS). Polynomic adjusted correlations were performed to model the relationship between the TAPSE/sPAP ratio and the RVFWLS, then we evaluated an interaction effect of the OS-ASD shunt (Qp/Qs ratio), respectively adjusted for age, sex, body mass index, body surface area and right atrial area. Results In our study, 49 (78%) subjects were male, with a mean age of 41.8 (±15) years; 7.94% (n=5) had mild PH, 42.9% (n=27) had moderate PH and 49.2% (n=31) had severe PH. Mean echocardiographic parameters were: TAPSE 24.5 (±5.1) mm , sPAP of 55.9 (±20.7) mmHg, TAPSE/sPAP 0.49 (±0.2) mm/mmHg, RVFWLS -25.6 (±6.6) % and Qp/Qs 2.9 (±0.9). We observed a quadratic relationship between the TAPSE/sPAP ratio and the RVFWLS (r=0.691, p &amp;lt; 0.001; Figure 1). OS-ASD shunt had a positive interaction effect (β=10.9, 95% CI: 2.09-19.6, p=0.018) on the relationship between TAPSE/sPAP and RVFWLS after adjusting for covariates (Figure 2). Conclusions In conclusion, in patients with OS-ASD, the RV systolic function decreases as the RV-PA uncoupling increases, as reflected in the quadratic regression between the TAPSE/sPAP and the RVFWLS. Moreover, the increase in OS-ASD shunt decreases RVFWLS values in relationship to the TAPSE/sPAP ratio as observed in the interaction model. These results could suggest that the OS-ASD characteristics could potentially mitigate RV dysfunction in patients with secondary PH.Figure 1.Quadratic regressionFigure 2.Interaction model

Abstract 16372: Prognostic Value of Baseline Right Ventricular Dysfunction Using TAPSE and TAPSE to PASP Ratio in Patients Undergoing Mitra-Clip: Systematic Review and Meta-Analysis

Introduction: Transcatheter edge-to-edge mitral valve repair (TEER) using Mitra-clip is an established therapy for high-risk surgical candidates who are refractory to optimal medical treatment. Several reports have shown that right ventricular dysfunction (RVD) is associated with increased morbidity and mortality in heart failure (HF) patients. Emerging data on the relationship between baseline RVD and post-TEER mortality has been published. Objective: Our main goal is to assess the prognostic impact of baseline RV function markers; tricuspid annular plane excursion (TAPSE) and TAPSE/PASP (pulmonary arterial systolic pressure) ratio, as an expression of the right ventricle-pulmonary artery coupling following Mitra-Clip. Methods: MEDLINE and EMBASE were searched for studies discussing outcomes of Mitra-Clip in patients with and without RV dysfunction as expressed by TAPSE or TAPSE:PASP ratio. Two reviewers independently screened the studies and extracted the pertinent survival data. Odds ratios (OR) with 95% confidence interval were calculated using a random-effects model. Results: Twelve reports enrolling 3515 patients (1443 with and 2072 without pre-existing RVD) were included. Patients with RVD had OS reduction after Mitra-Clip by 55% at 6 months, 60% at one year, and 63% at two years [OR: 0.45 (0.35-0.58), 0.40 (0.33-0.48), 0.37 (0.31-0.45) respectively; P &lt; .001] compared to normal RV group. Likewise, HR readmission free survival was minimized among RVD patients by 53% at 6 months, 56% at one year, and 59% at two years compared to normal RV group [OR: 0.47 (0.35-0.65), 0.44 (0.35-0.55), 0.41 (0.30-0.56) respectively; P &lt; .00001]. TAPSE:PASP ≤ 0.30-0.37 was associated with lower OS and HF re-admission free survival at 6 months (OR: 0.37, 0.44; P &lt; .00001) and 1 year (OR: 0.35, 0.41; P &lt; .00001) after Mitra-Clip. Furthermore, TAPSE ≤ 15-16 negatively impacted the OS at 6 months (OR: 0.40 P &lt; .00001) and 1 year (OR: 0.50; P &lt; .00001) after Mitra-Clip. Conclusions: Pre-existing RV dysfunction as expressed by TAPSE ≤15-16 or TAPSE:PASP ratio ≤ 0.30-0.37 decreased the overall survival and HF readmission free survival after Mitra-Clip therapy. Further research is warranted to guide interventional timing based on the degree of RV dysfunction.

Tricuspid Annular Plane Systolic Excursion/Pulmonary Arterial Systolic Pressure Ratio as a Predictor of Mortality in Heart Failure Patients

Aims: We aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in Moroccan patients with heart Failure (HF). &#x0D; Study Design: A retrospective study was conducted in The Cardiology Department of Ibn Rochd Hospital of Casablanca in Morocco. The study was conducted in the period between March 2012 to March 2016 with a follow-up until December 2022.&#x0D; Methods: data were evaluated from the HF register patients and their relatives were contacted by phone. Patients with reduced LVEF were included, patients with pulmonary embolism, and patients with HFpEF were excluded. The endpoint of the study was mortality.&#x0D; Results: 128 patients were enrolled Over an average follow-up of 58 months. 51(41.4%) patients died at the end of the follow-up, the median value of left ventricular ejection fraction was 35.2 ± 2.2%. Patients were stratified according to the TAPSE/PASP ratio (low &lt;0.32 mm/mmHg; high: &gt;0.32 mm/mmHg). Kaplan-Meier survival analysis showed that ten-year all-cause mortality was significantly higher in patients with TAPSE/PASP ≤0.32 mm/mmHg than in patients with TAPSE/PASP &gt; 0.32 mm/mmHg (log-rank 7.8, p =0.008) Cox regression analysis revealed that lower LVEF (p= 0.04), and a ratio of TAPSE\PAPS &lt;0.32 (p=0.02) were associated to an increase in all-cause mortality. &#x0D; Conclusion: Correlating right ventricular function to loading conditions may be more accurate in assessing its real contractility and predicting patients’ outcomes. Our study showed that TAPSE/PASP appears as a novel prognostic predictor in patients with Heart failure.

Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort.

The aim of the study was to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in the European Scleroderma Trials and Research (EUSTAR) cohort. Patients with systemic sclerosis (SSc) from the EUSTAR database with TAPSE, sPAP, and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival. A total of 2,370 patients with SSc were included; 284 (12%) patients had CKD stage 3a-5. TAPSE/sPAP (odds ratio [OR] 0.479; 95% CI 0.310-0.743; P < 0.001), arterial hypertension (OR 3.118; 95% CI 2.173-4.475; P < 0.001), diastolic dysfunction (OR 1.670; 95% CI 1.148-2.428; P < 0.01), and N-terminal pro-B-type natriuretic peptide (OR 1.165; 95% CI 1.041-1.304; P < 0.01) were associated with CKD stage 3a-5. TAPSE/sPAP ≤0.32 mm/mm Hg (hazard ratio [HR] 3.589; 95% CI 2.236-5.761; P < 0.001), eGFR <60 mL/min per 1.73 m2 (HR 2.818; 95% CI 1.777-4.468; P < 0.001), and age (HR 1.782; 95% CI 1.348-2.356; P < 0.001) were the most significant predictive factors for all-cause mortality. A total of 276 patients with SSc had pulmonary hypertension (PH) confirmed by right heart catheterization, with 69 (25%) having CKD stage 3a-5. No difference was found in eGFR between patients with PH with reduced or normal cardiac index. Reduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤0.32 mm/mm Hg and eGFR <60 mL/min per 1.73 m2 are prognostic factors for all-cause mortality. In patients with SSc with PH, eGFR is independent by reduced cardiac output.

Effects of sotatercept on haemodynamics and right heart function: analysis of the STELLAR trial.

In the phase 3 STELLAR trial, sotatercept, an investigational first-in-class activin signalling inhibitor, demonstrated beneficial effects on 6-min walk distance and additional efficacy endpoints in pre-treated participants with pulmonary arterial hypertension (PAH). This post hoc analysis evaluated data from right heart catheterisation (RHC) and echocardiography (ECHO) obtained from the STELLAR trial. Changes from baseline in RHC and ECHO parameters were assessed at 24 weeks. An analysis of covariance (ANCOVA) model was used to estimate differences in least squares means with treatment and randomisation stratification (mono/double versus triple therapy; World Health Organization functional class II versus III) as fixed factors, and baseline value as covariate. Relative to placebo, treatment with sotatercept led to significant (all p<0.0001 except where noted) improvements from baseline in mean pulmonary artery (PA) pressure (-13.9 mmHg), pulmonary vascular resistance (-254.8 dyn·s·cm-5), mean right atrial pressure (-2.7 mmHg), mixed venous oxygen saturation (3.84%), PA elastance (-0.42 mmHg·mL-1·beat-1), PA compliance (0.58 mL·mmHg-1), cardiac efficiency (0.48 mL·beat-1·mmHg-1), right ventricular (RV) work (-0.85 g·m) and RV power (-32.70 mmHg·L·min-1). ECHO showed improvements in tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure ratio (0.12 mm·mmHg-1), end-systolic and end-diastolic RV areas (-4.39 cm2 and -5.31 cm2, respectively), tricuspid regurgitation and RV fractional area change (2.04% p<0.050). No significant between-group changes from baseline were seen for TAPSE, heart rate, cardiac output, stroke volume or their indices. In pre-treated patients with PAH, sotatercept demonstrated substantial improvements in PA pressures, PA compliance, PA-RV coupling and right heart function.

Association of delayed diagnosis of pulmonary arterial hypertension with its prognosis

BackgroundCurrently, pulmonary hypertension-targeted therapy has been shown to improve the survival of patients with pulmonary artery hypertension (PAH). However, the importance of early diagnosis has not been investigated. Therefore, this study aimed to investigate whether a delayed diagnosis of PAH is associated with its prognosis. Methods and resultsA total of 66 consecutive untreated patients were diagnosed with PAH from January 2008 to December 2021 at the Kagoshima University Hospital. The time from symptom onset to diagnosis correlated with brain natriuretic peptide levels (p < 0.001), right ventricle (RV) Tei index (p < 0.001), and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio (p = 0.003). These findings suggest that in patients with PAH, RV function declines with increasing time from symptom onset to diagnosis. Furthermore, older patients with PAH appeared to have a longer time from symptom onset to diagnosis. Next, patients were divided into delayed diagnosis (>3 months) and early diagnosis (≤3 months) groups based on the time from symptom onset to diagnosis. Patients were categorized into three groups according to the European Society of Cardiology (or the European Respiratory Society) risk stratification guidelines. Patients diagnosed with PAH within 3 months of symptom onset were significantly in the low- or intermediate-risk groups (p < 0.001). A Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower (p < 0.01) in the delayed diagnosis group than in the early diagnosis group. A delayed diagnosis was significantly associated with a worse outcome than an early diagnosis, after adjusting for different sets of confounding factors. ConclusionsA delayed PAH diagnosis is associated with a poor prognosis. Early diagnosis of PAH may lead to a low-risk treatment. Furthermore, older patients need more careful screening for PAH.

Dyspnea in Post-Acute COVID-19: A Multi-Parametric Cardiopulmonary Evaluation.

Post-acute COVID-19 is characterized by the persistence of dyspnea, but the pathophysiology is unclear. We evaluated the prevalence of dyspnea during follow-up and factors at admission and follow-up associated with dyspnea persistence. After five months from discharge, 225 consecutive patients hospitalized for moderate to severe COVID-19 pneumonia were assessed clinically and by laboratory tests, echocardiography, six-minute walking test (6MWT), and pulmonary function tests. Fifty-one patients reported persistent dyspnea. C-reactive protein (p = 0.025, OR 1.01 (95% CI 1.00-1.02)) at admission, longer duration of hospitalization (p = 0.005, OR 1.05 (95% CI 1.01-1.10)) and higher body mass index (p = 0.001, OR 1.15 (95% CI 1.06-1.28)) were independent predictors of dyspnea. Absolute drop in SpO2 at 6MWT (p = 0.001, OR 1.37 (95% CI 1.13-1.69)), right ventricular (RV) global longitudinal strain (p = 0.016, OR 1.12 (95% CI 1.02-1.25)) and RV global longitudinal strain/systolic pulmonary artery pressure ratio (p = 0.034, OR 0.14 (95% CI 0.02-0.86)) were independently associated with post-acute COVID-19 dyspnea. In conclusion, dyspnea is present in many patients during follow-up after hospitalization for COVID-19 pneumonia. While higher body mass index, C-reactive protein at admission, and duration of hospitalization are predictors of persistent dyspnea, desaturation at 6MWT, and echocardiographic RV dysfunction are associated with this symptom during the follow-up period.

TAPSE/systolic pulmonary artery pressure in patients with repaired TOF: Does it correlate with cardiac magnetic resonance indices?

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Potential benefits and optimal timing of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) are still questionable because of high morbidity due to the need for reinterventions. Cardiac magnetic resonance (CMR) is a valuable tool for the detection of irreversible right ventricular (RV) remodelling. We sought to evaluate the relation between CMR derived volumes and peak tricuspid annular systolic excursion (TAPSE)/invasively measured systolic pulmonary artery pressure (sPAP) ratio in patients who underwent right heart catheterization. Methods One hundred and forty-eight patients with rTOF were evaluated; 26 of the patients either had right ventricular outflow tract obstruction or had corrective surgery with a pulmonary conduit. Patients with severe pulmonary regurgitation underwent CMR to quantify RV volumes and EF either before PVR or as part of the follow-up protocol including those who had previous PVR and recurrent pulmonary regurgitation. Echocardiographic indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. In a subset of patients who underwent right heart catheterization, systolic RV pressure, sPAP were recorded and TAPSE/invasively measured sPAP ratio was calculated. CMR derived volumes and EF were compared with TAPSE/sPAP. Results Forty-six patients with matching studies for echo, CMR and right heart catheterization were analyzed. Mean age of the patients were 28.0 ± 7.3 years. Mean tricuspid systolic annular velocity (S’), TAPSE, and fractional area change were 11.4 ± 2.9 cm/sec, 16.8 ± 2.9 cm, and 31.7 ± 4.2 %, respectively. CMR derived end-diastolic volume index, end-systolic volume index and EF were 154.6 ± 38.5 ml/m2, 97.4 ± 26.5 ml/m2and 40.0 ± 7.6 %, respectively. There was a negative correlation between TAPSE/sPAP and CMR derived end-diastolic volume index (r= −0.44, p = 0.049) and end-systolic volume index (r= −0.50, p = 0.024) but not with RV EF. Conclusion In patient with rTOF and significant pulmonary regurgitation, TAPSE/invasively measured sPAP is more strongly correlated to CMR derived end-systolic volume index as opposed to end-diastolic volume index. Our findings support the use of CMR derived end-systolic volume index preferentially in the decision making for PVR.

Tricuspid Regurgitation: Right Ventricular Volume Versus Pressure Load.

Tricuspid regurgitation is associated with increased mortality in proportion to right ventricular adaptation to increased volume loading and pulmonary artery pressure. We here review recent progress in the understanding of right ventricular adaptation to pre- and after-loading conditions for improved recommendations of tricuspid valve repair. Trans-catheter tricuspid valve repair has made the correction of tricuspid regurgitation more easily available, triggering a need of tighter indications. Several studies have shown the feasibility and relevance to the indications of tricuspid valve repair of imaging of right ventricular ejection fraction measured by magnetic resonance imaging or 3D-echocardiography, and the 2D-echocardiography of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio combined with invasively determined mean pulmonary artery pressure and pulmonary vascular resistance. Improved definitions of right ventricular failure and pulmonary hypertension may be considered in future recommendations on the treatment of tricuspid regurgitation.