Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis

Echo-derived pulmonary arterial systolic pressure (PASP) and right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE; from the end of diastole to end-systole) are of basic relevance in the clinical follow-up of heart failure (HF) patients, carrying two- to threefold increase in card...

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Published in:American journal of physiology. Heart and circulatory physiology 2013-11, Vol.305 (9), p.H1373-H1381
Main Authors: Guazzi, M, Bandera, F, Pelissero, G, Castelvecchio, S, Menicanti, L, Ghio, S, Temporelli, P L, Arena, R
Format: Article
Language:English
Subjects:
Aged
Arterial Pressure
Biomarkers - blood
Chi-Square Distribution
Circulatory system
Disease Progression
Echocardiography, Doppler
Female
Heart
Heart failure
Heart Failure - blood
Heart Failure - diagnostic imaging
Heart Failure - mortality
Heart Failure - physiopathology
Humans
Kaplan-Meier Estimate
Linear Models
Male
Medical prognosis
Middle Aged
Multivariate Analysis
Myocardial Contraction
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Physiology
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Pulmonary Artery - diagnostic imaging
Pulmonary Artery - physiopathology
Risk Factors
Stroke Volume
Time Factors
Tricuspid Valve - diagnostic imaging
Tricuspid Valve - physiopathology
Ventricular Function, Left
Ventricular Function, Right
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Summary:Echo-derived pulmonary arterial systolic pressure (PASP) and right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE; from the end of diastole to end-systole) are of basic relevance in the clinical follow-up of heart failure (HF) patients, carrying two- to threefold increase in cardiac risk when increased and reduced, respectively. We hypothesized that the relationship between TAPSE (longitudinal RV fiber shortening) and PASP (force generated by the RV) provides an index of in vivo RV length-force relationship, with their ratio better disclosing prognosis. Two hundred ninety-three HF patients with reduced (HFrEF, n = 247) or with preserved left ventricular (LV) ejection fraction (HFpEF, n = 46) underwent echo-Doppler studies and N-terminal pro-brain-type natriuretic peptide assessment and were tracked for adverse events. The median follow-up duration was 20.8 mo. TAPSE vs. PASP relationship showed a downward regression line shift in nonsurvivors who were more frequently presenting with higher PASP and lower TAPSE. HFrEF and HFpEF patients exhibited a similar distribution along the regression line. Given the TAPSE, PASP, and TAPSE-to-PASP ratio (TAPSE/PASP) collinearity, separate Cox regression and Kaplan-Meier analyses were performed: one with TAPSE and PASP as individual measures, and the other combining them in ratio form. Hazard ratios for variables retained in the multivariate regression were as follows: TAPSE/PASP
ISSN:0363-6135
1522-1539
DOI:10.1152/ajpheart.00157.2013