Tricuspid Regurgitation Velocity/ Tricuspid Annular Plane Systolic Excursion (TRV/TAPSE) ratio as an indicator of disease severity and prognosis in patients with precapillary pulmonary hypertension.

Abstract

Abstract Background: Tricuspid annular plane systolic excursion (TAPSE) and tricuspid regurgitation velocity (TRV) are two echocardiographic parameters with prognostic value in patients with pulmonary hypertension (PH). When analyzed concurrently as TRV/TAPSE ratio, they allow the ventricular-pulmonary artery coupling (RVPAC) to be assessed. This could better predict the disease severity in patients with PH. Objective: Our study aimed to evaluate the prognostic value of the TRV/TAPSE ratio echocardiographic parameter in adults with precapillary PH. Methods: The study included 39 patients (74% women; average age, 63 years) with precapillary PH: pulmonary arterial hypertension (PAH), and chronic thromboembolic PH (CTEPH). The mean follow-up period was 16,6 ±13,3 months. Twelve patients (31%) died during observation time. We measured TAPSE as a surrogate of RV contractility and TRV reflecting RV afterload, while ventricular–arterial coupling was evaluated by the ratio between these two parameters (TRV/TAPSE). To assess disease progression and the patient's functional capacity, World Health Organization functional class (WHO FC) was determined. Patient physical capacity was also evaluated using the 6-minute walk test (6MWT). The analysis included values of N-terminal prohormone brain natriuretic peptide (NT-proBNP), which were taken routinely during the follow-up visit. Results: The mean calculated TRV/TAPSE ratio was 0.26 ± 0.08 m/s/mm. On comparison of the TRV/TAPSE ratio to the disease prognostic indicators, we observed statistically significant correlation between TRV/TAPSE and the results of WHO FC, 6MWT and NT-proBNP. TRV/TAPSE ratio is thus a good predictor of mortality in PH patients (AUC, 0.781). Patients with a TRV/TAPSE ratio > 0.30 m/s/mm had a shorter survival time with log-rank test p< 0.0001. Additionally, ROC analysis revealed higher AUC for TRV/TAPSE than for TAPSE and TRV alone. Conclusions: TRV/TAPSE is a promising practicable echocardiographic parameter reflecting RVPAC. Moreover, TRV/TAPSE could be viable risk stratification parameter and could have prognostic value in patients with PH.