Follow-up tricuspid annular plane systolic excursion predicts survival in pulmonary arterial hypertension

Few studies have examined the utility of serial echocardiography in the evaluation, management, and prognosis of patients with pulmonary arterial hypertension (PAH). Therefore, we sought to evaluate the prognostic significance of follow-up tricuspid annular plane systolic excursion (TAPSE) in PAH. We prospectively studied 70 consecutive patients with PAH who underwent baseline right heart catheterization (RHC) and transthoracic echocardiogram, who survived to follow-up echocardiogram after initiation of PAH therapy. Baseline TAPSE was 1.6 +/- 0.5cm which increased to 2.0 +/- 0.4cm on follow-up (P<0.0001). The cohort was dichotomized by TAPSE at one-year follow-up: Group 1 (n=37): follow-up TAPSE >= 2cm; Group 2 (n=33): follow-up TAPSE<2cm. Group 1 participants were significantly more likely to reach WHO functional class I-II status and achieve a higher six-minute walk distance on follow-up. Of the 68 patients who survived more than one year, 18 died (26.5%) over a median follow-up of 941 days (range, 3-2311 days), with significantly higher mortality in Group 2 versus Group 1 (41.9% vs. 13.5%; P=0.003). While baseline TAPSE stratified at 2cm did not predict survival in this cohort, TAPSE >= 2cm at follow-up strongly predicted survival in bivariable models (hazard ratio, 0.21; 95% confidence interval, 0.08-0.60). In conclusion, follow-up TAPSE >= 2cm is a prognostic marker and potential treatment target in a PAH population.