When the expierence surpasses evidence in pulmonar hypertension
G Sorasio, P V Paul Vargas, V T Vanegas Tomas, B E Besmalinoviich Ezequiel, M M Mercado Mariela, S C N Silva Croome Nicolas, F M Figueroa Manuel, F I Fernandez Ianina, C P Costas Pablo, L D Lopez Daiana, P M Perez Maria, S Soricetti Julieta, C R Caprini Romina, C N Caruso Nicolas, L A Lescano AdrianAbstract
Introduction
Pulmonary hypertension (PH) guidelines incorporate clinical, functional, hemodynamic, and imaging variables as prognostic indicators. Right ventricular systolic function (RVSF) parameters, such as tricuspid annular plane systolic excursion (TAPSE), have been excluded from international scoring systems.
Objective
To determine the value of TAPSE as a prognostic value in our patients with PH.
Materials and Methods
Patients diagnosed with pulmonary hypertension (confirmed by right heart catherization) were inlcuded. Poor prognostic factors were defined according to international PH guidelines. The following data were recorded: demographics; pulmonary artery group; clinical variables: symptoms and functional class (FC); neurohormonal variables: brain natriuretic peptide (BNP); hemodynamic parameters: right atrial pressure and cardiac index (CI); functional parameters: distance in the 6-minute walk test; echocardiographic data: right ventricular systolic pressure (RVSP), TAPSE and pericardial effusion. The outcome was mortality during the two-year follow-up. TAPSE was analyzed as a single variable and dichotomized into >16 mm (A) and ≤16 mm (B). We used STATA 14 software. The T-test or Chi-square test was applied, depending on the variables. Logistic regression was used to determine the impact of TAPSE on mortality, and other univariate and multivariate analyses were performed.
Results
This multicenter, analytical, prospective study included 181 patients, with a mean age of 57 (± 16) years (25% male, 77% female). The PH group was: I 68%, II 13%, III 7%, and IV 7%. Prognostic factors included: advanced functional class (50%), syncope 22%, 6-minute walk distance (6MWD) ≤ 165 mmHg 60%, right atrial pressure (RAP) ≥ 14 mmHg 18%, cardiac index ≤ 2.2 L/min/m² 30%, BNP ≥ 300 pg/dL 52%, and pericardial effusion in 8%. Echocardiographic data revealed a moderate to severe impairment of the right ventricle in 24% and a mean TAPSE value of 16 mm (± 4.1) The relationship between mortality and mean TAPSE showed a significant association: 19.1 mm in survival group A (95% CI 18–20) vs. 15.8 mm in group B (95% CI 14.5–17.1), with a p-value of 0.003. We observed lower mortality in group A (17% vs. 47%; p = 0.001). Multivariate analysis showed a correlation between mortality and variables, including age, heart failure, syncope, and TAPSE value (p < 0.005). When the groups were combined, group B showed a β coefficient of 1.5 (0.5–2.4), with greater variation than the other variables (p = 0.001). The OR for group B was 4.5, with a stronger association than the other variables (age, CI, syncope), and a model fit of 76.6%.
Conclusion
In this population diagnosed with HP, a significant relationship was observed between the TAPSE score and mortality. A TAPSE score ≤ 16 was independently associated with mortality. These findings highlight the need for a large-scale study to determine the prognostic role of this parameter.