Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension

Tello, Khodr; Axmann, Jens; Ghofrani, Hossein Ardeschir; Naeije, Robert; Narcin, Newroz; Rieth, Andreas; Seeger, Werner; Gall, Henning; Richter, Manuel J.

doi:10.1016/j.ijcard.2018.01.053

Cited by 199 publications

(170 citation statements)

References 40 publications

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“…Subsequent studies con rmed its prognostic capability, not only in heart failure (21) but also in pulmonary arterial hypertension (22) and in patients with chronic lung diseases (23). In these studies, the TAPSE/PASP was assumed to inform about RV-PA coupling, with TAPSE considered as a load-dependent surrogate of Ees and PASP as an indirect estimate of Ea (21)(22)(23). The TAPSE/PASP has been shown to be superior to other composite echocardiographic indices in the assessment of RV-PA and correlated to gold standard invasive (11) or indirectly assessed Ees/Ea ratios.…”

Section: Discussionmentioning

confidence: 95%

“…The TAPSE/PASP ratio was initially proposed as an estimate of RV myocardial length-tension relationship, and as such showed to be of prognostic relevance in heart failure (20). Subsequent studies con rmed its prognostic capability, not only in heart failure (21) but also in pulmonary arterial hypertension (22) and in patients with chronic lung diseases (23). In these studies, the TAPSE/PASP was assumed to inform about RV-PA coupling, with TAPSE considered as a load-dependent surrogate of Ees and PASP as an indirect estimate of Ea (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

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Right Ventricular-Arterial Uncoupling Independently Predicts Survival in COVID-19 ARDS

D′Alto

Marra

Severino

et al. 2020

Preprint

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Aim. To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an acute respiratory distress syndrome (ARDS).Methods. Ninety-four consecutive patients (mean age 64 yrs) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results. The majority of patients needed ventilatory support, which was non-invasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62±13 vs 68±12 years, p=0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270±104 vs 117±57 mmHg, p<0.001). In the non-survivors, PASP was increased (42±12 vs 30±7 mmHg, p<0.001), while TAPSE was decreased (19±4 vs 25±4 mm, p<0.001). Accordingly the TAPSE/PASP ratio was lower than in the survivors (0.51±0.22 vs 0.89±0.29 mm/mmHg, p<0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR:0.026; 95%CI:0.01-0.579; p:0.019) and PaO2/FIO2 (HR:0.988; 95%CI:0.988-0.998; p:0.018) ratios were the only independent predictors of mortality, with ROC-determined cut-off values of 159 mmHg and 0.635 mm/mmHg respectively.Conclusions. COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Right Ventricular-Arterial Uncoupling Independently Predicts Survival in COVID-19 ARDS

D′Alto

Marra

Severino

et al. 2020

Preprint

Self Cite

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“…A promising echocardiographic parameter that could help to answer the question as to how many cardiopulmonary reserves have been exhausted is the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). A growing body of evidence suggests that this ratio provides more information than either parameter considered alone and that it reflects the extent of ventriculo-arterial uncoupling-a central event in the progression from RV dysfunction to failure-and that the TAPSE/PASP ratio may help stratify risk in patients and is associated with relevant clinical adverse outcomes [32][33][34][35][36].…”

Section: The Role Of Echocardiographymentioning

confidence: 99%

The Right Ventricle—You May Forget It, But It Will Not Forget You

Wanner

Filipovic

2020

JCM

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Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.

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“…There is evidence supporting the role of assessments of TAPSE, PASP and TAPSE/PASP ratio in pulmonary hypertension (8)(9)(10)(11)(12). Pulmonary hypertension is common in patients undergoing TAVR and about 42% of patients in the TAVR arm of the PARTNER trial (13) had baseline pulmonary hypertension.…”

Section: Editorialmentioning

confidence: 99%