Divisions of Pulmonary and Critical Care Medicine, Cardiology, and Rheumatology, Department of Medicine, Johns Hopkins, University School of Medicine, Baltimore, Maryland, USA.
J Rheumatol. 2011 Nov;38(11):2410-8. doi: 10.3899/jrheum.110512. Epub 2011 Oct 1.
The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH.
Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed.
The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m(2)). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m(2); p < 0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p < 0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p < 0.01).
TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc.
三尖瓣环平面收缩期位移（TAPSE）强烈反映右心室（RV）功能，并预测特发性肺动脉高压（PAH）的生存率。但它在系统性硬化症（SSc）相关的 PAH 中的作用尚未确定。我们的目的是验证 TAPSE 在评估 SSc-PAH 患者 RV 功能和预测生存率中的作用。
连续 50 例 SSc-PAH 患者在临床指示右心导管检查后 1 小时内行超声心动图检查并测量 TAPSE，前瞻性随访。评估 TAPSE 与 RV 功能和生存率的测量值之间的关系。
大多数队列为纽约心脏协会（NYHA）心功能 III/IV 级的女性，伴有严重的 PAH（平均心指数 2.4±0.8 l/min/m2）。RV 功能明显受损（平均心指数 2.1±0.7 比 2.9±0.8 l/min/m2；p<0.01），RV 后负荷明显增加（平均肺动脉阻力 11.1±5.1 比 5.8±2.5 伍德单位；p<0.01）在 TAPSE≤1.7 cm 的患者中。TAPSE 低值组的生存率明显较低[0.56（95%CI 0.37-0.71）和 0.46（95%CI 0.28-0.62）与 0.87（95%CI 0.55-0.96）和 0.79（95%CI 0.49-0.93），1 年和 2 年生存率]。TAPSE≤1.7 cm 使死亡风险增加近 4 倍（HR 3.81，95%CI 1.31-11.1，p<0.01）。
TAPSE 是 RV 功能的有力指标，强烈预测 PAH-SSc 患者的生存率。需要进一步研究来确定 TAPSE 对 PAH 特异性治疗的反应性，并评估其在 PAH-SSc 中的诊断效用。
