PH Survival in Chronic Lung Disease Predicted by Echocardiographic Parameters

The ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) is a simple echocardiographic parameter that shows hemodynamic severity and can predict survival in pulmonary hypertension (PH) due to lung diseases, according to study results published in European Respiratory Journal.

Complete echocardiographic and invasive hemodynamic data from patients with PH due to lung diseases was retrospectively analyzed for the ratio of TAPSE as a surrogate for contractility and PASP as a surrogate for afterload. Correlations between these values and disease severity were evaluated.

Of the 172 patients with pulmonary hypertension due to lung diseases, 78 had PH due to chronic obstructive pulmonary disease (COPD), and the remaining 94 due to interstitial lung disease. In total, 65 of the 172 study participants were considered severe. The forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) ratio was higher in patients with severe vs nonsevere PH due to COPD, but FEV₁ was not different. There was also no correlation between FEV₁/FVC or FEV₁ and the TAPSE/PASP ratio in the severe and nonsevere groups.

Receiver operating characteristic analysis identified a cutoff of 0.26 mm·mm Hg^-1 for TAPSE/PASP with a sensitivity of 80.6% and a specificity of 71.2% to discriminate between severe and nonsevere PH due to lung diseases.

“The TAPSE/PASP ratio is a straightforward and clinically relevant measurement to differentiate between the haemodynamic phenotypes of patients with pulmonary hypertension due to lung diseases,” the researchers wrote. “The TAPSE/PASP ratio might prove to be an important non-invasive tool for the evaluation of future therapeutic interventions in patients with PH-[lung disease].”

Reference

Tello K, Ghofrani H, Heinze C, et al. A simple echocardiographic estimate of right ventricular-arterial coupling to assess severity and outcome in pulmonary hypertension on chronic lung disease [published online May 9, 2019]. Eur Respir J. doi:10.1183/13993003.02435-2018

This article originally appeared on Pulmonology Advisor