Tricuspid annular plane systolic excursion is a robust outcome measure in systemic sclerosis-associated pulmonary arterial hypertension

Stephen C. Mathai, Christopher Sibley, Paul R. Forfia, James Mudd, Micah R. Fisher, Ryan J. Tedford, Noah Lechtzin, Danielle Boyce, Laura K. Hummers, Traci Housten, Ari L. Zaiman, Reda E. Girgis, Paul M. Hassoun

    Research output: Contribution to journalArticle

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    Abstract

    Objective. The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH. Methods. Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed. Results. The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m 2). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m 2; p <0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p <0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p <0.01). Conclusion. TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc. The Journal of Rheumatology

    Original languageEnglish (US)
    Pages (from-to)2410-2418
    Number of pages9
    JournalJournal of Rheumatology
    Volume38
    Issue number11
    DOIs
    StatePublished - Nov 2011

    Fingerprint

    Systemic Scleroderma
    Pulmonary Hypertension
    Right Ventricular Function
    Outcome Assessment (Health Care)
    Survival
    Rheumatology
    Cardiac Catheterization
    Vascular Resistance
    Echocardiography

    Keywords

    • Echocardiography
    • Pulmonary hypertension
    • Survival
    • Systemic sclerosis

    ASJC Scopus subject areas

    • Rheumatology
    • Immunology
    • Immunology and Allergy

    Cite this

    Tricuspid annular plane systolic excursion is a robust outcome measure in systemic sclerosis-associated pulmonary arterial hypertension. / Mathai, Stephen C.; Sibley, Christopher; Forfia, Paul R.; Mudd, James; Fisher, Micah R.; Tedford, Ryan J.; Lechtzin, Noah; Boyce, Danielle; Hummers, Laura K.; Housten, Traci; Zaiman, Ari L.; Girgis, Reda E.; Hassoun, Paul M.

    In: Journal of Rheumatology, Vol. 38, No. 11, 11.2011, p. 2410-2418.

    Research output: Contribution to journalArticle

    Mathai, SC, Sibley, C, Forfia, PR, Mudd, J, Fisher, MR, Tedford, RJ, Lechtzin, N, Boyce, D, Hummers, LK, Housten, T, Zaiman, AL, Girgis, RE & Hassoun, PM 2011, 'Tricuspid annular plane systolic excursion is a robust outcome measure in systemic sclerosis-associated pulmonary arterial hypertension', Journal of Rheumatology, vol. 38, no. 11, pp. 2410-2418. https://doi.org/10.3899/jrheum.110512
    Mathai, Stephen C. ; Sibley, Christopher ; Forfia, Paul R. ; Mudd, James ; Fisher, Micah R. ; Tedford, Ryan J. ; Lechtzin, Noah ; Boyce, Danielle ; Hummers, Laura K. ; Housten, Traci ; Zaiman, Ari L. ; Girgis, Reda E. ; Hassoun, Paul M. / Tricuspid annular plane systolic excursion is a robust outcome measure in systemic sclerosis-associated pulmonary arterial hypertension. In: Journal of Rheumatology. 2011 ; Vol. 38, No. 11. pp. 2410-2418.
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    abstract = "Objective. The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH. Methods. Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed. Results. The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m 2). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m 2; p <0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p <0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95{\%} CI 0.37-0.71) and 0.46 (95{\%} CI 0.28-0.62) vs 0.87 (95{\%} CI 0.55-0.96) and 0.79 (95{\%} CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95{\%} CI 1.31-11.1, p <0.01). Conclusion. TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc. The Journal of Rheumatology",
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    author = "Mathai, {Stephen C.} and Christopher Sibley and Forfia, {Paul R.} and James Mudd and Fisher, {Micah R.} and Tedford, {Ryan J.} and Noah Lechtzin and Danielle Boyce and Hummers, {Laura K.} and Traci Housten and Zaiman, {Ari L.} and Girgis, {Reda E.} and Hassoun, {Paul M.}",
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    T1 - Tricuspid annular plane systolic excursion is a robust outcome measure in systemic sclerosis-associated pulmonary arterial hypertension

    AU - Mathai, Stephen C.

    AU - Sibley, Christopher

    AU - Forfia, Paul R.

    AU - Mudd, James

    AU - Fisher, Micah R.

    AU - Tedford, Ryan J.

    AU - Lechtzin, Noah

    AU - Boyce, Danielle

    AU - Hummers, Laura K.

    AU - Housten, Traci

    AU - Zaiman, Ari L.

    AU - Girgis, Reda E.

    AU - Hassoun, Paul M.

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    N2 - Objective. The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH. Methods. Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed. Results. The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m 2). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m 2; p <0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p <0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p <0.01). Conclusion. TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc. The Journal of Rheumatology

    AB - Objective. The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH. Methods. Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed. Results. The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m 2). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m 2; p <0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p <0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p <0.01). Conclusion. TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc. The Journal of Rheumatology

    KW - Echocardiography

    KW - Pulmonary hypertension

    KW - Survival

    KW - Systemic sclerosis

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