Abstract
Purpose: Heart failure with preserved ejection fraction (HFpEF) is closely associated with right heart dysfunction. Our study aimed to elucidate the association between HFpEF and the TAPSE/sPAP ratio.
Materials and Methods: This retrospective observational study was conducted at a tertiary care cardiology clinic. A total of 64 patients diagnosed with HFpEF based on clinical criteria and an H2FPEF score ≥5 were included, along with 62 age- and sex-matched controls without heart failure symptoms. Demographic characteristics, laboratory markers, including NT-proBNP, and echocardiographic measurements were recorded. Particular attention was given to assessing right heart function using the TAPSE/sPAP ratio.
Results: The TAPSE/sPAP ratio was lower in patients with HFpEF than in controls (median 0.76 vs. 0.96). Patients with HFpEF also had higher NT-proBNP levels (median 2136.5 pg/mL vs. 136.5 pg/mL) and higher H2FPEF scores. A TAPSE/sPAP cut-off value of 0.843 was identified, which showed 70.3% sensitivity and 72.6% specificity in distinguishing HFpEF. Correlation analysis revealed that lower TAPSE/sPAP ratios were associated with higher NT-proBNP levels, elevated H2FPEF scores, and increased left atrial volume index.
Conclusion: The evaluation of the TAPSE/sPAP ratio in patients suspected of having HFpEF may be useful. Notably, TAPSE/sPAP predicted HFpEF regardless of EF in the multivariate analysis. In addition, their significant relationship with H2FPEF score and NT-proBNP levels strengthened their prognostic value.
References
- Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: a review. JAMA. 2023;329:827-38.
- Borlaug BA, Sharma K, Shah SJ, Ho JE. Heart failure with preserved ejection fraction: JACC Scientific Statement. J Am Coll Cardiol. 2023;81:1810-34.
- Zhou Y, Zhu Y, Zeng J. Research update on the pathophysiological mechanisms of heart failure with preserved ejection fraction. Curr Mol Med. 2023;23:54-62.
- Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53:1119-26.
- Yavuz YE, Soylu A, Gürbüz AS. The relationship of systemic and pulmonary arterial parameters with HFpEF scores (H2 FPEF, HFA-PEFF) and diastolic dysfunction parameters in heart failure patients with preserved ejection fraction. J Clin Ultrasound. 2024;52:39-50.
- Wang Z, Fang J, Hong H. Evaluation the value of H2FPEF score and HFA-PEFF step E score in the diagnosis of heart failure with preserved ejection fraction. Acta Cardiol. 2023;78:790-95.
- Hirano R, Ikemura N, Nguyen DD, Jones PG, Kimura T, Katsumata Y et al. Clinical utility of the h2fpef score in patients with early atrial fibrillation. JACC Heart Fail. 2024;12:1302-5.
- Aydınyılmaz F, Guliyev İ, Özbeyaz NB, Algül E, Aker M, Şahan HF et al. Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients. Biomark Med 2023;17:197-207.
- Fauve C, Dillinger JG, Rossanaly Vasram R, Bouleti C, Logeart D, Roubille F et al. In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure. Eur Heart J Cardiovasc Imaging. 2024;25:1099-108.
- Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E et al. Prognostic value of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in cardiac amyloidosis. Rev Esp Cardiol (Engl Ed). 2024;77:634-44.
- Çizgici AY, Gulmez R, Kahraman S, Güner EG, Güler A, Kalkan AK et al. Utility of TAPSE/sPAP ratio in acute pulmonary embolism as valuable prognostic marker as PESI score. Koşuyolu Heart Journal. 2023;26:128-38.
- Bok Y, Kim JY, Park JH. Prognostic role of right ventricular-pulmonary artery coupling assessed by TAPSE/PASP ratio in patients with acute heart failure. J Cardiovasc Imaging. 2023;31:200-6.
- Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452-62.
- Mohammed SF, Hussain I, AbouEzzeddine OF, Takahama H, Kwon SH, Forfia P et al. Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation. 2014;130:2310-20.
- Obokata M, Reddy YNV, Melenovsky V, Pislaru S, Borlaug BA. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur Heart J. 2019;40:689-97.
- Colalillo A, Pellicano C, Ananyeva LP, Hachulla E, Cuomo G, Györfi AH et al. Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio and cardiorenal syndrome type 2 in the systemic sclerosis EUSTAR cohort. Arthritis Care Res (Hoboken). 2025;77:257-65.
- Alves Da Silva P, Brito J, Silva B, Garcia B, Martins AM, Oliveira C et al. Joining efforts for the non-invasive evaluation in pulmonary hypertension: TAPSE/sPAP ratio. Eur Heart J Cardiovasc Imaging. 2023;24(Suppl 1):jead119-409.
- Lv G, Li A, Zhai Y, Li L, Deng M, Lei J et al. Assessment of right ventricle-to-pulmonary artery coupling by three-dimensional echocardiography in pre-capillary pulmonary hypertension: comparison with tricuspid annular plane systolic excursion /systolic pulmonary artery pressure ratio. BMC Med Imaging. 2025;25:108.
- Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618-731.
- Aydınyılmaz F, Guliyev İ, Özbeyaz NB, Algül E, Aker M, Şahan HF et al. Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients. Biomark Med. 2023;17:197-207.
- Fauvel C, Dillinger JG, Rossanaly Vasram R, Bouleti C, Logeart D, Roubille F et al. In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure. Eur Heart J Cardiovasc Imaging. 2024;25:1099-108.
- Bandera F, Ghizzardi G, Agnifili M, Pizzocri S, Boveri S, Alfonzetti E et al. Hemodynamic correlates of tricuspid annular pulmonary systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio in heart failure with reduced ejection fraction. Eur Heart J. 2019;40(Suppl 1):ehz745-0151.
Abstract
Amaç: Korumalı ejeksiyon fraksiyonlu kalp yetersizliği (KEF-KY), sağ kalp disfonksiyonu ile yakından ilişkilidir. Bu çalışmada, KEF-KY hastaları ile TAPSE/sPAP oranı arasındaki ilişkinin ortaya konması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışma, üçüncü basamak bir kardiyoloji kliniğinde yürütülmüş retrospektif ve gözlemsel bir araştırmadır. Klinik kriterlere ve H2FPEF skoru ≥5 olan toplam 64 HFpEF hastası ile kalp yetersizliği semptomları olmayan, yaş ve cinsiyet açısından eşleştirilmiş 62 sağlıklı kontrol bireyi çalışmaya dahil edilmiştir. Katılımcıların demografik özellikleri, NT-proBNP gibi laboratuvar belirteçleri ve ekokardiyografik ölçümleri kaydedilmiştir. Özellikle TAPSE/sPAP oranı kullanılarak sağ kalp fonksiyonları değerlendirilmiştir.
Bulgular: TAPSE/sPAP oranı, KEF-KY hastalarında kontrol grubuna göre daha düşük bulunmuştur (medyan 0.76’ya karşı 0.96). Ayrıca KEF-KY grubunda NT-proBNP düzeyleri (medyan 2136.5 pg/mL’ye karşı 136.5 pg/mL) ve H2FPEF skorları daha yüksek saptanmıştır. TAPSE/sPAP oranı için belirlenen 0.843 kesim değeri, KEF-KY’yi ayırt etmede %70.3 duyarlılık ve %72.6 özgüllük göstermiştir. Korelasyon analizlerinde düşük TAPSE/sPAP oranları ile yüksek NT-proBNP düzeyleri, artmış H2FPEF skorları ve yükselmiş sol atriyum hacim indeksi arasında anlamlı ilişkiler gözlemlenmiştir.
Sonuç: KEF-KY şüphesi olan hastalarda TAPSE/sPAP oranının değerlendirilmesi yol gösterici olabilir. Özellikle bu oran, ejeksiyon fraksiyonundan bağımsız olarak KEF-KY’yi öngörebilmekte ve H2FPEF skoru ile NT-proBNP ile olan anlamlı ilişkisi, prognostik değerini güçlendirmektedir.
Keywords
References
- Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: a review. JAMA. 2023;329:827-38.
- Borlaug BA, Sharma K, Shah SJ, Ho JE. Heart failure with preserved ejection fraction: JACC Scientific Statement. J Am Coll Cardiol. 2023;81:1810-34.
- Zhou Y, Zhu Y, Zeng J. Research update on the pathophysiological mechanisms of heart failure with preserved ejection fraction. Curr Mol Med. 2023;23:54-62.
- Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53:1119-26.
- Yavuz YE, Soylu A, Gürbüz AS. The relationship of systemic and pulmonary arterial parameters with HFpEF scores (H2 FPEF, HFA-PEFF) and diastolic dysfunction parameters in heart failure patients with preserved ejection fraction. J Clin Ultrasound. 2024;52:39-50.
- Wang Z, Fang J, Hong H. Evaluation the value of H2FPEF score and HFA-PEFF step E score in the diagnosis of heart failure with preserved ejection fraction. Acta Cardiol. 2023;78:790-95.
- Hirano R, Ikemura N, Nguyen DD, Jones PG, Kimura T, Katsumata Y et al. Clinical utility of the h2fpef score in patients with early atrial fibrillation. JACC Heart Fail. 2024;12:1302-5.
- Aydınyılmaz F, Guliyev İ, Özbeyaz NB, Algül E, Aker M, Şahan HF et al. Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients. Biomark Med 2023;17:197-207.
- Fauve C, Dillinger JG, Rossanaly Vasram R, Bouleti C, Logeart D, Roubille F et al. In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure. Eur Heart J Cardiovasc Imaging. 2024;25:1099-108.
- Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E et al. Prognostic value of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in cardiac amyloidosis. Rev Esp Cardiol (Engl Ed). 2024;77:634-44.
- Çizgici AY, Gulmez R, Kahraman S, Güner EG, Güler A, Kalkan AK et al. Utility of TAPSE/sPAP ratio in acute pulmonary embolism as valuable prognostic marker as PESI score. Koşuyolu Heart Journal. 2023;26:128-38.
- Bok Y, Kim JY, Park JH. Prognostic role of right ventricular-pulmonary artery coupling assessed by TAPSE/PASP ratio in patients with acute heart failure. J Cardiovasc Imaging. 2023;31:200-6.
- Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452-62.
- Mohammed SF, Hussain I, AbouEzzeddine OF, Takahama H, Kwon SH, Forfia P et al. Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation. 2014;130:2310-20.
- Obokata M, Reddy YNV, Melenovsky V, Pislaru S, Borlaug BA. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur Heart J. 2019;40:689-97.
- Colalillo A, Pellicano C, Ananyeva LP, Hachulla E, Cuomo G, Györfi AH et al. Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio and cardiorenal syndrome type 2 in the systemic sclerosis EUSTAR cohort. Arthritis Care Res (Hoboken). 2025;77:257-65.
- Alves Da Silva P, Brito J, Silva B, Garcia B, Martins AM, Oliveira C et al. Joining efforts for the non-invasive evaluation in pulmonary hypertension: TAPSE/sPAP ratio. Eur Heart J Cardiovasc Imaging. 2023;24(Suppl 1):jead119-409.
- Lv G, Li A, Zhai Y, Li L, Deng M, Lei J et al. Assessment of right ventricle-to-pulmonary artery coupling by three-dimensional echocardiography in pre-capillary pulmonary hypertension: comparison with tricuspid annular plane systolic excursion /systolic pulmonary artery pressure ratio. BMC Med Imaging. 2025;25:108.
- Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618-731.
- Aydınyılmaz F, Guliyev İ, Özbeyaz NB, Algül E, Aker M, Şahan HF et al. Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients. Biomark Med. 2023;17:197-207.
- Fauvel C, Dillinger JG, Rossanaly Vasram R, Bouleti C, Logeart D, Roubille F et al. In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure. Eur Heart J Cardiovasc Imaging. 2024;25:1099-108.
- Bandera F, Ghizzardi G, Agnifili M, Pizzocri S, Boveri S, Alfonzetti E et al. Hemodynamic correlates of tricuspid annular pulmonary systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio in heart failure with reduced ejection fraction. Eur Heart J. 2019;40(Suppl 1):ehz745-0151.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | November 22, 2024 |
| Acceptance Date | May 23, 2025 |
| Published in Issue | Year 2025 Volume: 50 Issue: 2 |
