CHEST Guidelines-Unlocking-the-Hidden-Pearls-of-Using-Tricuspid-Ann

Unlocking-the-Hidden-Pearls-of-Using-Tricuspid-Ann

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The article explores the use of the Tricuspid Annulus Plane Systolic Excursion to Pulmonary Arterial Systolic Pressure (TAPSE/PASP) ratio in assessing pulmonary hypertension (PH) prognosis, particularly for patients with suspected or mild PH. Michele D’Alto and Marco Guazzi highlight the role of the right ventricle (RV) in transferring energy efficiently to the pulmonary artery for maintaining blood flow. RV-Pulmonary Artery (PA) coupling indicates the RV's ability to handle increased afterload and continues until RV-PA uncoupling appears, signaling functional deterioration.<br /><br />Traditionally, RV contractility and afterload measurements have been invasive procedures, but the TAPSE/PASP ratio offers a noninvasive alternative, increasingly used for clinical assessments. This ratio has been recommended by the guidelines for pulmonary hypertension diagnosis, risk stratification, and prognosis.<br /><br />The study conducted by John et al. focuses on patients with left heart diseases, chronic lung diseases, or risk factors for PH development. They found that in patients with normal or slightly elevated mean pulmonary artery pressure at rest, the TAPSE/PASP ratio was linked to exercise capacity and was a predictive marker for mortality and clinical worsening. A TAPSE/PASP below 0.63 was associated with poorer outcomes over a two-year follow-up, emphasizing the importance of detecting RV-PA uncoupling even in early or mild disease.<br /><br />The article raises unanswered questions regarding the significance of TAPSE/PASP changes during follow-up, the goal range for therapeutic interventions, and its use in patients without overt PH. Further research is encouraged to fully understand the prognostic potential of the TAPSE/PASP ratio, and its integration into routine clinical assessments alongside other echocardiographic indicators.

Keywords

TAPSE/PASP ratio

pulmonary hypertension

RV-PA coupling

right ventricle

noninvasive assessment

clinical prognosis

exercise capacity

mortality prediction

echocardiographic indicators

therapeutic interventions