Objectives: Determinate the value of TAPSE as a prognosic value in our patients with PH.
Methods: Patients (P) with diagnosis of PH (between 2012 and 2018), confirmed by right heart catheterization (mean pulmonary pressure = 25mmHg), were included. The data was recorded: demographic; PH group (G); clinical variables: symptoms and functional class (FC), neurohormonal: brain natriuretic peptide (BNP), hemodynamic parameters: right atrium (RA) pressure and cardiac index (CI); functional: 6 minute walk test distance (6MW), Ed data: RVSF, TAPSE and pericardial effusion (PE). Poor prognosis factors were defined according to PH international guidelines (between moderate/high risk): heart failure history, syncope, advanced FC (III/IV), 6MW <160m, BNP =300pg/dl, PE presence, RA =14mmHg and CI =2,2 l/min/m2. The outcome was follow up Mortality (M) within two years. TAPSE was analyzed as an integral variable and was dichotomized in > 16 mm (A) and = 16 mm (B). We use the STATA 14 program. T test or Chi-squared was applied, according to the variables. The logistic regression model was used to determinate the impact of TAPSE in M, integrate in a multivariate analysis.
Results: Multicentric, analytical, prospective, included 141 P, with a 25% M, 77% female and 57 (± 18) mean age. PH G was: I 68%, II 13%, III 7 % IV 7%, V 5%. Among the prognostic factors, we highlight: advanced FC 50%, syncope 22%, 6MWT =160m 16%, RA =14 mmHg 18%, IC =2,2 26%, BNP = 300 52% and PE in 30%. Within the Ed observed: 79% RVSF deterioration (24% moderate, 18% severe), a mean TAPSE value of 18 mm (± 4,1), with 75% group A and 25% group B distribution. The relationship between M and mean TAPSE probed a significant association: 19,1 mm in the survival A group (CI 95% 18-20) vs 15,8 mm in the B group (CI 95% 14,5-17,1) and a p value: 0,003. Likewise we observe less mortality in the A group (17 vs 47%; p: 0,001). The multivariate analysis shows a correlation between mortality and different variables, such as age, HF, syncope and TAPSE value (p<0.005). When we integrate the groups, we observe that the group B presents a ß coefficient of 1,5 (0,5-2,4), with greater variation than the rest of the variables (p=0,001).The OR of the group B was 4,5, with a higher association force than the rest of the variables (age, HF, syncope), and a model adequacy of 76.6%.
Conclusions:In this population with PH diagnosis, a significant relationship between TAPSE value and Mis observed. The dichotomization of TAPSE = 16, associate in an independent way with M. These findings highlight the necessity of designing a great scale study to determinate the prognostic role of that parameter.