Interest of TAPSE/sPAP ratio for noninvasive pulmonary arterial hypertension risk assessment

Fauvel, Charles; Raitiere, O; Boucly, Athénaïs; Groote, P. De; Renard, Sébastien; Bertona, Jeanne; Lamblin, Nicolas; Artaud-Macari, Élise; Viacroze, Catherine; Schleifer, D.; Dominique, S.; Pichon, Jérémie; Jaïs, Xavier; Montani, David; Sitbon, Olivier; Savale, Laurent; Humbert, Marc

doi:10.1016/j.healun.2022.09.005

Cited by 41 publications

(32 citation statements)

References 47 publications

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“…When considering echocardiographic variables, the absolute changes in PASP and TAPSE were modest, but the TAPSE/PASP ratio, representing an index of RV‐PA coupling, 30,31 improved substantially in both subgroups. The prognostic impact of such changes has recently been confirmed 45 . Taken together, the magnitude of changes and the values reached upon initiation of rapid sequential combination therapy in the patients reported herein appear of major clinical relevance.…”

Section: Discussionsupporting

confidence: 63%

“…In fact, invasive haemodynamics were best able to capture the treatment response in patients with ‘PAH with co‐morbidities’, whereas 6MWD and WHO‐FC may be influenced and limited by co‐morbidities themselves. The consideration of the TAPSE/PASP ratio may help to overcome limitations in this context 45 . This highlights the importance of the methodology used when performing risk assessment and judging upon the treatment response particularly in elderly PAH patients with co‐morbidities.…”

Section: Discussionmentioning

confidence: 99%

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Impact of rapid sequential combination therapy on distinct haemodynamic measures in newly diagnosed pulmonary arterial hypertension

Kramer,

Nattmann,

Gerhardt

et al. 2024

ESC Heart Failure

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AimsIn pulmonary arterial hypertension (PAH), upfront combination therapy with ERA and PDE5i is associated with a reduction in morbidity and mortality events and improves standard haemodynamics, but data remain limited. Aims of this study were (i) to capture detailed haemodynamic effects of rapid sequential dual combination therapy in patients with newly diagnosed PAH; (ii) to monitor the impact of treatment initiation on clinical variables and patients' risk status, and (iii) to compare the treatment effect in patients with ‘classical PAH’ and ‘PAH with co‐morbidities’.MethodsFifty patients (median age 57 [42–71] years, 66% female) with newly diagnosed PAH (76% idiopathic) were treated with a PD5i/sGC‐S or ERA, followed by addition of the respective other drug class within 4 weeks. All patients underwent repeat right heart catheterization (RHC) during early follow‐up.ResultsAt early repeat RHC (7 ± 2 months), there were substantial reductions in mean pulmonary artery pressure (mPAP: 52.2 ± 13.5 to 39.0 ± 10.6 mmHg; −25.3%), and pulmonary vascular resistance (PVR: 12.1 ± 5.7 to 5.8 ± 3.1 WU; −52.1%), and an increase in cardiac index (2.1 ± 0.4 to 2.7 ± 0.7 mL/min/m2; +32.2%) (all P < 0.05). Haemodynamic improvements correlated with improved clinical parameters including 6‐min walking distance (336 ± 315 to 389 ± 120 m), NTproBNP levels (1.712 ± 2.024 to 506 ± 550 ng/L, both P < 0.05) and WHO‐FC at 12 months, resulting in improved risk status, and were found in patients with few (n = 37) or multiple cardiovascular co‐morbidities (BMI > 30 kg/m2, hypertension, diabetes, coronary artery disease [≥3]; n = 13), albeit baseline PVR in PAH patients with multiple co‐morbidities was lower (9.3 ± 4.4 vs. 13.1 ± 5.9 WU) and PVR reduction less pronounced compared with those with few co‐morbidities (−42.7% vs. −54.7%). However, comprehensive haemodynamic assessment considering further variables of prognostic relevance such as stroke volume index and pulmonary artery compliance showed similar improvements among the two groups (SVI: +50.0% vs. +49.2%; PAC: 91.7% vs. 100.0%). Finally, the 4‐strata risk assessment approach was better able to capture treatment response as compared with other approaches, particularly in patients with co‐morbidities.ConclusionsRapid sequential combination therapy with PDE5i/sGC‐S and ERA substantially ameliorates cardiopulmonary haemodynamics at early follow‐up in patients without, and to a lesser extent, with cardiovascular co‐morbidities. This occurs in line with improvements of clinical parameters and risk status.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Impact of rapid sequential combination therapy on distinct haemodynamic measures in newly diagnosed pulmonary arterial hypertension

Kramer,

Nattmann,

Gerhardt

et al. 2024

ESC Heart Failure

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“…Noninvasive measures of right ventricular structure and function by echocardiography or cardiac MRI are useful in risk stratification and have been incorporated into management guidelines. 120 , 121 The recent European Society of Cardiology/European Respiratory Society guidelines include right atrial area, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) and presence of pericardial effusion among risk stratification variables. 3 Risk assessment tools integrate multiple clinical parameters to predict whether a patient is at low, moderate or high risk of near-term death from PAH, and as such, guide the approach to medical treatment design.…”

Section: Risk Assessment and Treatment Of Who Group 1 Pahmentioning

confidence: 99%

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

Swisher¹,

Weaver²

2023

VHRM

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Pulmonary hypertension may develop as a disease process specific to pulmonary arteries with no identifiable cause or may occur in relation to other cardiopulmonary and systemic illnesses. The World Health Organization (WHO) classifies pulmonary hypertensive diseases on the basis of primary mechanisms causing increased pulmonary vascular resistance. Effective management of pulmonary hypertension begins with accurately diagnosing and classifying the disease in order to determine appropriate treatment. Pulmonary arterial hypertension (PAH) is a particularly challenging form of pulmonary hypertension as it involves a progressive, hyperproliferative arterial process that leads to right heart failure and death if untreated. Over the last two decades, our understanding of the pathobiology and genetics behind PAH has evolved and led to the development of several targeted disease modifiers that ameliorate hemodynamics and quality of life. Effective risk management strategies and more aggressive treatment protocols have also allowed better outcomes for patients with PAH. For those patients who experience progressive PAH with medical therapy, lung transplantation remains a life-saving option. More recent work has been directed at developing effective treatment strategies for other forms of pulmonary hypertension, such as chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary hypertension due to other lung or heart diseases. The discovery of new disease pathways and modifiers affecting the pulmonary circulation is an ongoing area of intense investigation.

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“…Das Verhältnis von TAPSE (Tricuspid annular Plane systolic Excursion) zu systolischem pulmonalarteriellem Druck (TAPSE/sPAP-Ratio) wurde kürzlich vs. Konduktanz-Katheter als Surrogat-Parameter für das "RV-PA-Uncoupling" validiert [14]. Weitere Untersuchungen zeigten, dass die TAPSE/sPAP-Ratio bei Patienten mit Herzinsuffizienz und PH einen prognostischen Marker darstellt und zudem zur Risikostratifikation und Ermittlung der Überlebenswahrscheinlichkeit bei präkapillärer PH eingesetzt werden kann [15,16]. Zudem ist die TAPSE/sPAP-Ratio auch ein sensitiver Marker zur Detektion einer PH [17].…”

Section: Diagnostisches Vorgehen Bei Pulmonaler Hypertonie Assoziiert...unclassified

Pulmonale Hypertonie im Zusammenhang mit Linksherzerkrankungen (Gruppe 2)

Wissmüller,

Tichelbäcker,

Finke

et al. 2023

Dtsch Med Wochenschr

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Interest of TAPSE/sPAP ratio for noninvasive pulmonary arterial hypertension risk assessment

Cited by 41 publications

References 47 publications

Impact of rapid sequential combination therapy on distinct haemodynamic measures in newly diagnosed pulmonary arterial hypertension

Impact of rapid sequential combination therapy on distinct haemodynamic measures in newly diagnosed pulmonary arterial hypertension

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

Pulmonale Hypertonie im Zusammenhang mit Linksherzerkrankungen (Gruppe 2)

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