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TAPSE/PASP Ratio: Unveiling a Key Predictor of Pulmonary Hypertension in Acute Pulmonary Embolism
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 02 – HIPERTENSÃO PULMONAR: DESENVOLVIMENTOS NA ESTRATIFICAÇÃO DE RISCO, DIAGNÓSTICO E TRATAMENTO
Speaker:
Sofia Esteves
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.6 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia Esteves; Miguel Azaredo Raposo; Ana Abantes; Daniel Inácio Cazeiro; Diogo Rosa Ferreira; João Mendes Cravo; Nuno Lousada; Susana Gonçalves; Sara Lopes; Catarina Sousa; Fausto J. Pinto; Rui Plácido
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Pulmonary hypertension (PH) is a serious complication of pulmonary embolism (PE), arising from persistent vessel obstruction. Early diagnosis and intervention can help reduce the risk of PH, but clinical predictors remain limited. The TAPSE/PASP ratio correlates with right ventricle-pulmonary artery (RV-PA) coupling. A low TAPSE/PASP ratio, indicating RV-PA uncoupling, has been linked to a poor prognosis in patients with acute PE. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the TAPSE/PASP ratio in patients with acute PE and assess its correlation with prognosis, namely with the development of PH. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Observational, single-center study conducted on intermediate-risk acute PE patients. Clinical and echocardiographic data were prospectively collected from hospital records between 2019 and 2021. To assess the diagnostic performance of the TAPSE/PASP ratio in predicting PH development, a ROC curve was generated, and the area under the curve (AUC) was calculated. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 166 patients were included, (46.4% male, median age of 76 years). The most common comorbidities were hypertension (66.9%), dyslipidemia (47.6%), and active cancer (26.5%)- table 1. The in-hospital mortality rate was 7.4%. Echocardiographic data showed a median TAPSE of 20 mm and a median PASP of 37 mmHg, with a mean TAPSE/PASP ratio of 0.53. 44.2% of patients had a ratio > 0.55, and 55.8% had a ratio ≤0.55. During a median follow-up (FUP) of 43.5 months, 50% of patients died, with 29.6% of these deaths attributed to cardiovascular causes. 9.9% of patients developed PH. A TAPSE/PASP ratio <0.44 showed a sensitivity of 80.3% and a specificity of 72.7% for predicting PH development during FUP (AUC: 0.758)- figure 1. TAPSE/PASP was found to be an independent predictor of development of PH during FUP (OR 9.91, 95% CI: 2.318-42.319, p value = 0.002). However, when analyzing the subgroup of patients with PASP <60 mmHg, the effect was more modest, not meeting statistical significance (p value= 0.09). </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> A TAPSE/PASP ratio <0.44 was associated with the diagnosis of PH during FUP, but this effect was attenuated after excluding patients with PASP> 60. A low TAPSE/PASP ratio should prompt clinicians to provide both comprehensive diagnostic investigation and close FUP of these patients, as they present a higher risk of having either preexisting PH or developing it in the future.</span></span></span><br /> </p>
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