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

Abstract

Ghio S, Temporelli PL, Arena R. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 305: H1373-H1381, 2013. First published August 30, 2013; doi:10.1152/ajpheart.00157.2013.-Echoderived 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 ϭ 247) or with preserved left ventricular (LV) ejection fraction (HFpEF, n ϭ 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 Ͻ/Ն 0.36 mm/mmHg [hazard ratio (HR): 10.4, P Ͻ 0.001]; TAPSE Ͻ/Ն 16 mm (HR: 5

Colchicine Depolymerizes Microtubules, Increases Junctophilin‐2, and Improves Right Ventricular Function in Experimental Pulmonary Arterial Hypertension

“…RV‐PA coupling was defined 2 ways: TAPSE divided by invasively measured mean pulmonary artery pressure (mPAP) and percentage change in RVFW thickness/mPAP as previously described 29, 30, 31, 32, 33…”

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

“…Available data regarding Plot of tricuspid annular peak systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) relationship according to heart failure reduced ejection fraction (HFrEF; n=247, red symbols) vs HF preserved ejection fraction (HFpEF; n=46, blue symbols). 43 The overall right ventricular (RV) performance relationship was similar in both groups, and both HFpEF and HFrEF were homogeneously distributed across the relationship, suggesting that a similar degree of RV dysfunction may occur irrespective of left ventricular morphological characteristics and predominance of systolic or diastolic dysfunction. Reprinted from Guazzi et al 43 with permission of the publisher.…”

“…43 The overall right ventricular (RV) performance relationship was similar in both groups, and both HFpEF and HFrEF were homogeneously distributed across the relationship, suggesting that a similar degree of RV dysfunction may occur irrespective of left ventricular morphological characteristics and predominance of systolic or diastolic dysfunction. Reprinted from Guazzi et al 43 with permission of the publisher. Copyright © 2013, The American Physiological Society.…”

“…6 Studies investigating the pattern of right heart function and geometry in PH-HFpEF are summarized in Table 1. [9][10][11]14,15,21,[40][41][42][43][44][45] In a report by Puwanant et al, 11 RV dysfunction, assessed by RV fractional area and tissue Doppler S prime, was not uncommon in patients with HFpEF although in a milder degree compared with HFrEF. Similar findings were reported by looking at RV global longitudinal early diastolic strain rate and systolic RV global longitudinal systolic strain.…”

“…Although the prevalence of a severely compromised RV function (tricuspid annular plane systolic excursion, TAPSE <14 mm) was lower in patients with HFpEF than in patients with HFrEF (19% versus 39%), a similar prediction power was found for the lower TAPSE irrespective of systolic or diastolic origin of left-sided PH. In a recent study by our group, 43 we studied the RV contractile function in a mixed HFpEF and HFrEF population by plotting the relationship between TAPSE, as an index of fiber shortening versus pulmonary arterial systolic pressure (PASP), as an indicator of developed force and proposing this relationship as an in vivo noninvasive, easy-to-obtain index of length/force relationship. As shown in Figure 4, the overall RV contractile performance was similarly distributed across the regression line in both populations, suggesting that the RV may be similarly exposed to variable loads irrespective of the quality of LV systolic dysfunction.…”