Follow-up tricuspid annular plane systolic excursion predicts survival in pulmonary arterial hypertension

Abstract

Few studies have examined the utility of serial echocardiography in the evaluation, management, and prognosis of patients with pulmonary arterial hypertension (PAH). Therefore, we sought to evaluate the prognostic significance of follow-up tricuspid annular plane systolic excursion (TAPSE) in PAH. We prospectively studied 70 consecutive patients with PAH who underwent baseline right heart catheterization (RHC) and transthoracic echocardiogram, who survived to follow-up echocardiogram after initiation of PAH therapy. Baseline TAPSE was 1.6 ± 0.5 cm which increased to 2.0 ± 0.4 cm on follow-up ( P < 0.0001). The cohort was dichotomized by TAPSE at one-year follow-up: Group 1 (n = 37): follow-up TAPSE ≥ 2 cm; Group 2 (n = 33): follow-up TAPSE < 2 cm. Group 1 participants were significantly more likely to reach WHO functional class I-II status and achieve a higher six-minute walk distance on follow-up. Of the 68 patients who survived more than one year, 18 died (26.5%) over a median follow-up of 941 days (range, 3-2311 days), with significantly higher mortality in Group 2 versus Group 1 (41.9% vs. 13.5%; P = 0.003). While baseline TAPSE stratified at 2 cm did not predict survival in this cohort, TAPSE ≥ 2 cm at follow-up strongly predicted survival in bivariable models (hazard ratio, 0.21; 95% confidence interval, 0.08-0.60). In conclusion, follow-up TAPSE ≥ 2 cm is a prognostic marker and potential treatment target in a PAH population.

Keywords: follow-up; pulmonary arterial hypertension (PAH); right ventricular function; survival; tricuspid annular plane systolic excursion (TAPSE).

Fig. 1.

Schematic of patient enrollment. Echo, echocardiogram; 6MWT, 6-minute walk test; RHC, right heart catheterization; CTEPH, chronic thromboembolic pulmonary hypertension; CHD, congenital heart disease; ILD, interstitial lung disease.

Fig. 2.

Line plot of TAPSE trend. Individual baseline and follow-up TAPSE for patients with follow-up TAPSE ≥ 2 cm.

Fig. 3.

Baseline and follow-up CO and SVI and TAPSE subgroups. (a) Bar graphs compare baseline and follow-up CO within and between the follow-up TAPSE subgroups. *P = 0.001, †P = not significant, ‡P = 0.03. (b) Bar graphs compare baseline and follow-up SVI within and between the follow-up TAPSE subgroups. *P < 0.001, †P = 0.02, ‡P = 0.05. CO, cardiac output; TAPSE, tricuspid annular plane systolic excursion; SVI, stroke volume index.

Fig. 4.

Kaplan–Meier estimates of survival stratified by TAPSE values. (a) Survival stratified by baseline TAPSE value < 2 cm or ≥ 2 cm. (b) Survival stratified by follow-up TAPSE value < 2 cm or ≥ 2 cm. Numbers below each figure represent the number of patients at risk for death at each time point.