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Multicenter Study
. 2025 Nov;18(11):e012518.
doi: 10.1161/CIRCHEARTFAILURE.124.012518. Epub 2025 Sep 17.

TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension

Roberto Badagliacca  1 , Khodr Tello  2 , Michele D'Alto  3 , Stefano Ghio  4 , Paola Argiento  3 , Natale Daniele Brunetti  5 , Vito Casamassima  6 , Gavino Casu  7 , Nadia Cedrone  8 , Marco Confalonieri  9 , Marco Corda  10 , Michele Correale  11 , Carlo D'Agostino  12 , Lucrezia De Michele  12 , Domenico Filomena  1 , Giuseppe Galgano  6 , Alessandra Greco  4 , Carlo Mario Lombardi  13 , Rosalinda Madonna  14 , Giovanna Manzi  1 , Valentina Mercurio  15 , Alexandra Mihai  1 , Massimiliano Mulè  16 , Giuseppe Paciocco  17 , Silvia Papa  1 , Zvonimir Andelko Rako  2 , Tommaso Recchioni  1 , Manuel Richter  2 , Antonella Romaniello  18 , Emanuele Romeo  3 , Laura Scelsi  4 , Davide Stolfo  19 , Patrizio Vitulo  20 , Athiththan Yogeswaran  2 , Robert Naeije  21 , Raymond L Benza  22 , Carmine Dario Vizza  1 ; Italian Pulmonary Hypertension Network (iPHNET) and the Giessen PH Registry
Collaborators, Affiliations
Multicenter Study

TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension

Roberto Badagliacca et al. Circ Heart Fail. 2025 Nov.

Abstract

Background: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-pulmonary artery (PA) coupling evaluated by the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) improves risk assessment scores for survival prediction.

Methods: A total of 677 consecutive patients with PAH (55% idiopathic) were prospectively enrolled with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months (interquartile range, 180-344 days) after initiation of targeted therapies in 11 Italian centers. European Society of Cardiology/European Respiratory Society guidelines-derived risk scores and REVEAL 2.0 (US Registry to Evaluate Early and Long-Term PAH Disease Management 2.0) risk scores were collected at baseline and follow-up. 254 consecutive patients with PAH retrospectively enrolled in a German reference center served as a validation cohort.

Results: A low-risk status at a median of 3.7 years (interquartile range, 1.2-6.8) follow-up was significantly associated with each unit (0.1 mm/mm Hg) increase in TAPSE/sPAP under targeted therapies (European Society of Cardiology/European Respiratory Society score: odds ratio, 1.78; P≤0.001; REVEAL 2.0 score: odds ratio, 1.43; P≤0.001). At follow-up, the TAPSE/sPAP ratio increased the prognostic information of each risk stratum of the European Society of Cardiology/European Respiratory Society risk score, except the highest risk stratum, with 0.5 mm/mm Hg, 0.35 mm/mm Hg, and 0.30 mm/mm Hg, from the lowest to the intermediate-high risk score, identified as the best cutoff value. TAPSE/sPAP ratio increased the prognostic information of the REVEAL 2.0 score at follow-up, with 0.35 mm/mm Hg identified as the best cutoff value to discriminate within a score of 5 to 8, with no added value for scores <5 and >8. These results were confirmed in the validation cohort.

Conclusions: Assessment of right ventricular-PA coupling by the TAPSE/sPAP ratio in PAH improves risk assessment scores except in the lowest or most advanced stage of the disease.

Keywords: cardiology; humans; odds ratio; prognosis; pulmonary artery.

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Conflict of interest statement

Dr Vizza reports personal fees from GSK, UT, Dompè, Bayer, and MSD, outside the submitted work. Dr Badagliacca reports personal fees from UT, Dompè, Ferrer, Bayer, MSD, AOP Orphan Pharmaceuticals, and Gossamer Bio, outside the submitted work. Dr D’Alto reports personal fees from Bayer, Dompè, GSK, MSD, and Ferrer, outside the submitted work. Dr Naeije reports personal fees from UT, Lung Biotechnology, Johnson & Johnson, Acthelion, and AOP Orphan Pharmaceuticals outside the submitted work. The other authors report no conflicts.

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