Tricuspid annular displacement predicts survival in pulmonary hypertension

Paul R. Forfia, Micah R. Fisher, Stephen C. Mathai, Traci Housten-Harris, Anna R. Hemnes, Barry A Borlaug, Elzbieta Chamera, Mary C. Corretti, Hunter C. Champion, Theodore P. Abraham, Reda E. Girgis, Paul M. Hassoun

Research output: Contribution to journalArticle

667 Citations (Scopus)

Abstract

Rationale: Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. Objectives: To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. Methods: We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. Results: In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm2/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. Conclusions: TAPSE powerfully reflects RV function and prognosis in PAH.

Original languageEnglish (US)
Pages (from-to)1034-1041
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume174
Issue number9
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

Fingerprint

Right Ventricular Function
Pulmonary Hypertension
Survival
Cardiac Catheterization
Atrial Remodeling
Confidence Intervals
Right Ventricular Dysfunction
Patient Rights
Hemodynamics
Therapeutics

Keywords

  • Prognosis
  • Pulmonary arterial hypertension
  • Right ventricular function
  • TAPSE
  • Tricuspid annular displacement

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Forfia, P. R., Fisher, M. R., Mathai, S. C., Housten-Harris, T., Hemnes, A. R., Borlaug, B. A., ... Hassoun, P. M. (2006). Tricuspid annular displacement predicts survival in pulmonary hypertension. American Journal of Respiratory and Critical Care Medicine, 174(9), 1034-1041. https://doi.org/10.1164/rccm.200604-547OC

Tricuspid annular displacement predicts survival in pulmonary hypertension. / Forfia, Paul R.; Fisher, Micah R.; Mathai, Stephen C.; Housten-Harris, Traci; Hemnes, Anna R.; Borlaug, Barry A; Chamera, Elzbieta; Corretti, Mary C.; Champion, Hunter C.; Abraham, Theodore P.; Girgis, Reda E.; Hassoun, Paul M.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 174, No. 9, 01.11.2006, p. 1034-1041.

Research output: Contribution to journalArticle

Forfia, PR, Fisher, MR, Mathai, SC, Housten-Harris, T, Hemnes, AR, Borlaug, BA, Chamera, E, Corretti, MC, Champion, HC, Abraham, TP, Girgis, RE & Hassoun, PM 2006, 'Tricuspid annular displacement predicts survival in pulmonary hypertension', American Journal of Respiratory and Critical Care Medicine, vol. 174, no. 9, pp. 1034-1041. https://doi.org/10.1164/rccm.200604-547OC
Forfia, Paul R. ; Fisher, Micah R. ; Mathai, Stephen C. ; Housten-Harris, Traci ; Hemnes, Anna R. ; Borlaug, Barry A ; Chamera, Elzbieta ; Corretti, Mary C. ; Champion, Hunter C. ; Abraham, Theodore P. ; Girgis, Reda E. ; Hassoun, Paul M. / Tricuspid annular displacement predicts survival in pulmonary hypertension. In: American Journal of Respiratory and Critical Care Medicine. 2006 ; Vol. 174, No. 9. pp. 1034-1041.
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AU - Forfia, Paul R.

AU - Fisher, Micah R.

AU - Mathai, Stephen C.

AU - Housten-Harris, Traci

AU - Hemnes, Anna R.

AU - Borlaug, Barry A

AU - Chamera, Elzbieta

AU - Corretti, Mary C.

AU - Champion, Hunter C.

AU - Abraham, Theodore P.

AU - Girgis, Reda E.

AU - Hassoun, Paul M.

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N2 - Rationale: Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. Objectives: To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. Methods: We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. Results: In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm2/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. Conclusions: TAPSE powerfully reflects RV function and prognosis in PAH.

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KW - Prognosis

KW - Pulmonary arterial hypertension

KW - Right ventricular function

KW - TAPSE

KW - Tricuspid annular displacement

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