TAPSE/sPAP比值在肺动脉高压患者死亡率预测中的作用：其在患者风险分层中的价值。
The role of the TAPSE/sPAP ratio as a predictor of mortality in Pulmonary Arterial Hypertension: Its value for patient risk stratification.
作者信息
Palacios-Moguel Paul, Cueto-Robledo Guillermo, González-Pacheco Héctor, Ortega-Hernández Jorge, Torres-Rojas María Berenice, Navarro-Vergara Dulce Iliana, García-Cesar Marisol, González-Nájera Cinthia Alejandra, Narváez-Oríani Carlos Alfredo, Sandoval Julio
机构信息
Intensive Care Unit, American British Cowdray Medical Center, Mexico City.
Pulmonary Hypertension Clinic, General Hospital of Mexico Eduardo Liceaga, Mexico City.
出版信息
JHLT Open. 2024 Oct 19;7:100168. doi: 10.1016/j.jhlto.2024.100168. eCollection 2025 Feb.
BACKGROUND
The tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) ratio has been proposed as an indicator of ventriculo-arterial coupling, predicting right ventricular failure (RVF) and mortality in patients with pulmonary arterial hypertension (PAH).
OBJECTIVE
To evaluate the usefulness of the TAPSE/sPAP ratio in predicting outcomes and improving risk stratification in patients with PAH.
METHODS
156 patients with PAH were included. Clinical, functional, echocardiographic, and haemodynamic variables, along with the TAPSE/sPAP ratio, were analysed based on etiological PAH subgroups and outcomes. Additional statistical measures, such as the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement, assessed the predictive ability of TAPSE/sPAP in combination with the ESC/ERS risk score, and other risk assessment strategies (COMPERA and Reveal Lite 2).
RESULTS
Most patients were female (86.5%), with a median age of 45.5 (IQR: 29-58) years. The TAPSE/sPAP ratio for the whole group was 0.26 (IQR: 0.190-0.347) mm/mmHg, which was similar among different aetiologies, but different between deceased and surviving patients (0.14 vs. 0.27 mm/mmHg, respectively, < 0.001). A TAPSE/sPAP ratio <0.18 mm/mmHg independently predicted mortality (AUC: 0.859, 95% CI: 0.766- 0.952; < 0.001). Integration with the ESC/ERS risk score improved predicted mortality (AUC: 0.87 vs. 0.75, = 0.002) and risk stratification, reclassifying 14.28% of events and 36.92% of non-events, with an NRI of 39.4% ( < 0.001). Likewise, integration with other scores improved predicted ability of COMPERA and REVEA Lite2; COMPERA+TAPSE/sPAP (AUC: 0.837 vs 0.742; = 0.005) and REVEAL Lite 2 +TAPSE/sPAP (AUC: 0.840 vs. 0.713; < 0.001).
CONCLUSIONS
A TAPSE/sPAP ratio <0.18 mm/mmHg predicts mortality in PAH. The combination of the TAPSE/sPAP ratio with the ESC/ERS risk score improved risk stratification, and reclassification emphasizing the potential of ESC/ERS+TAPSE/sPAP as a valuable tool for risk assessment and clinical decision-making in PAH patients. Integration of TAPSE/sPAP ratio with other scores (COMPERA and (REVEAL Lite 2) also improved the risk stratification and reclassification of these risk scores.
背景
三尖瓣环平面收缩期位移与收缩期肺动脉压（TAPSE/sPAP）比值已被提议作为心室动脉耦联的指标，可预测肺动脉高压（PAH）患者的右心室衰竭（RVF）和死亡率。
目的
评估TAPSE/sPAP比值在预测PAH患者预后及改善风险分层中的作用。
方法
纳入156例PAH患者。基于PAH病因亚组和预后分析临床、功能、超声心动图及血流动力学变量，以及TAPSE/sPAP比值。其他统计指标，如曲线下面积（AUC）、净重新分类指数（NRI）和综合判别改善，评估TAPSE/sPAP与欧洲心脏病学会/欧洲呼吸学会（ESC/ERS）风险评分及其他风险评估策略（COMPERA和Reveal Lite 2）联合使用时的预测能力。
结果
多数患者为女性（86.5%），中位年龄45.5岁（四分位间距：29 - 58岁）。全组TAPSE/sPAP比值为0.26（四分位间距：0.190 - 0.347）mm/mmHg，不同病因间相似，但死亡患者与存活患者不同（分别为0.14 vs. 0.27 mm/mmHg，P < 0.001）。TAPSE/sPAP比值<0.18 mm/mmHg可独立预测死亡率（AUC：0.859，95%置信区间：0.766 - 0.952；P < 0.001）。与ESC/ERS风险评分联合使用可改善死亡率预测（AUC：0.87 vs. 0.75，P = 0.002）及风险分层，重新分类14.28%的事件和36.92%的非事件，NRI为39.4%（P < 0.001）。同样，与其他评分联合使用可提高COMPERA和REVEA Lite2的预测能力；COMPERA + TAPSE/sPAP（AUC：0.837 vs 0.742；P = 0.005）和REVEAL Lite 2 + TAPSE/sPAP（AUC：0.840 vs. 0.713；P < 0.001）。
结论
TAPSE/sPAP比值<0.18 mm/mmHg可预测PAH患者的死亡率。TAPSE/sPAP比值与ESC/ERS风险评分联合使用可改善风险分层，重新分类突出了ESC/ERS + TAPSE/sPAP作为PAH患者风险评估和临床决策有价值工具的潜力。TAPSE/sPAP比值与其他评分（COMPERA和REVEAL Lite 2）联合使用也改善了这些风险评分的风险分层和重新分类。
Zotero 插件