• Teresa John, Alexander Avian, Nikolaus John, Antonia Eger, Vasile Foris, Katarina Zeder, Horst Olschewski, Manuel Richter, Khodr Tello, Gabor Kovacs, and Philipp Douschan.
• Division of Pulmonology, Graz, Austria.
• Chest. 2024 Sep 26.

BackgroundEchocardiographic tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary arterial pressure (sPAP) ratio is a noninvasive surrogate for right ventricle (RV)-pulmonary arterial (PA) coupling. It has been related to outcome in patients with moderate to severe pulmonary hypertension (PH).Research QuestionIs RV-PA coupling of prognostic relevance in patients with suspected PH, but only normal or mildly elevated mean pulmonary arterial pressure (mPAP), and is it associated with impaired exercise capacity and exercise hemodynamics?.Study Design And MethodsPatients with mPAP of < 25 mm Hg who underwent echocardiography and exercise right heart catheterization in our PH clinic were analyzed retrospectively. Mild PH was defined as mPAP of 21 to 24 mm Hg and exercise PH (EPH) was defined as an mPAP to cardiac output (CO) slope of > 3 mm Hg/L/min. Multivariate analysis was performed to identify independent predictors for clinical worsening (CW), defined by disease-related hospitalization, transplantation, or death.ResultsTwo hundred thirty-seven patients (155 female with median age, 64 years [interquartile range (IQR), 54-73 years]; no PH: n = 147; mild PH: n = 90; EPH: n = 202) were included. During the observation time of 63 months (IQR, 29-104 months), 36 patients died and 126 CW events occurred. TAPSE to sPAP ratio was an age- and sex-independent predictor of mortality (hazard ratio [HR], 0.09; 95% CI, 0.01-0.62; P = .014) and CW (HR, 0.05; 95% CI, 0.35-0.78; P = .002). TAPSE to sPAP ratio also was correlated significantly to 6-minute walk distance (6MWD; r = 0.33; P < .001) and exercise hemodynamics (mPAP to CO slope: rρ = -0.56; P < .001). The best multivariate predictive model for CW in this population consisted of TAPSE to sPAP ratio (HR, 0.71; 95% CI, 0.53-0.95; P = .021), NT-proBNP (HR, 1.15; 95% CI, 0.99-1.34; P = .065), and 6MWD (HR, 0.998; 95% CI, 0.995-1.00; P = .042).InterpretationIn patients with suspected PH, but normal or only mildly elevated resting mPAP, TAPSE to sPAP ratio is an independent predictor of outcome. In addition, it is associated significantly with exercise capacity and exercise hemodynamics and may be a helpful tool in the prediction of future CW of this patient population.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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