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Published ahead of print on August 3, 2006, doi:10.1164/rccm.200604-547OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 9, November 2006, 1034-1041

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Submitted on April 20, 2006
Accepted on August 3, 2006

Tricuspid Annular Displacement Predicts Survival in Pulmonary Hypertension

Paul R Forfia1, Micah R Fisher2, Stephen C Mathai2, Traci Housten-Harris2, Anna R Hemnes2, Barry A Borlaug1, Elzbieta Chamera1, Mary C Corretti1, Hunter C Champion1, Theodore P Abraham1, Reda E Girgis2, and Paul M Hassoun2*

1 Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA, 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA

* To whom correspondence should be addressed. E-mail: phassoun{at}jhmi.edu.

Rationale: Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV 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 (PH). Methods: We prospectively studied 63 consecutive patients with PH 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 < 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-LV disproportion (RV/LV diastolic area-1.7 vs. 1.2; all P<0.001) vs. a TAPSE ≥ 1.8 cm. In patients with pulmonary arterial hypertension (PAH, n=47), survival estimates at one/two years were 94%/88% in those with a TAPSE ≥ 1.8 cm vs. 60%/50% in subjects with a TAPSE < 1.8 cm. The unadjusted risk of death (HR) in patients with a TAPSE < 1.8 vs. ≥ 1.8 cm was 5.7 (95% CI 1.3-24.9, P=0.02) for the PAH cohort. For every one millimeter decrease in TAPSE, the unadjusted risk of death increased by 17% (HR 1.17, 95% CI 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.
Key words: TAPSE. Tricuspid annular displacement, right ventricular function, pulmonary arterial hypertension, prognosis




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