PURPOSE: Tricuspid annular plane systolic excursion (TAPSE) predicts survival in prevalent pulmonary arterial hypertension (PAH). We sought to determine the clinical and prognostic significance of baseline pre-therapy TAPSE (TAPSEBL) vs. serial TAPSE (TAPSEserial) on pulmonary hypertension (PH) specific therapy in incident PAH.
METHODS: Clinical and echo-Doppler data were collected at incident PAH diagnosis (pre-therapy) and at one year (serial) on PH specific therapy. Group 1=TAPSEserial ≥ 2.0 cm; group 2=TAPSEserial < 2.0 cm. Data presented as mean±SD or median;IQR.
RESULTS: In this cohort (n=37), 50% had idiopathic PAH, 30% connective tissue disease, and 20% other associated PAH. Therapies included: 65% PDE5i and/or ERA, 35% prostacyclin; 68% combination therapy. Baseline mPAP 52 mmHg, PVR 11 mmHg/L/min, and cardiac index 2.2 L/min/m2. Baseline six minute walk distance (6MWD) was 309±128 m and New York Heart Association (NYHA) functional class was 2.8. The TAPSEBL was 1.6±0.5 cm. Group 1 (n=22) TAPSEserial was 2.3±0.2 cm; group 2 (n=15) TAPSEserial was 1.6±0.2 cm (p<0.0001). There were no differences in age or PAH diagnosis between the groups. Group 1 vs. 2 had similar and improved NYHA class (2.2 vs. 2.4; p=ns) and 6MWD (390 vs. 392 meters; p=ns). Group 1 had a two-fold increase in 6MWD vs. group 2 (+110 vs. +54 meters; p=0.17). Group 1 had markedly lower NT-proBNP levels (154; 129-248 vs. 1985; 657-10688 pg/ml; p=0.002). There was one death in group 1 and five deaths in group 2 over a median of 2 years. Kaplan Meier analysis revealed that TAPSEBL was not associated with differences in survival (TAPSEBL ≥2.0, 83%; TAPSEBL <2.0, 76%; hazard ratio 1.3: p=0.78). In contrast, TAPSEserial ≥2.0 cm was associated with an impressive 93% survival vs. 56% survival when TAPSEserial was <2.0 cm (hazard ratio 5.9: p=0.03).
CONCLUSIONS: In incident PAH, on-therapy TAPSEserial, not pre-treatment TAPSEBL, is associated with differences in survival.
CLINICAL IMPLICATIONS: In incident PAH, TAPSEserial at one year on therapy predicts survival and may provide an important treatment target in PAH.
DISCLOSURE: The following authors have nothing to disclose: Anjali Fields, Justin Roberts, Paul Forfia
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