The ratio of TAPSE to PASP predicts prognosis in lung transplant candidates with pulmonary arterial hypertension

Lung transplantation (LT) is the only option for patients with pulmonary arterial hypertension (PAH) refractory to maximal medical therapy. However, some patients referred for LT could survive without LT, and its determinants remain unclear. This study aimed to elucidate prognostic factors of severe PAH at the referral time. We retrospectively analyzed 34 patients referred for LT evaluation. The primary outcome was a composite of death or LT. Over a median follow-up period of 2.56 years, eight patients received LT and eight died. Compared with LT-free survival group, pulmonary arterial systolic pressure (PASP) was higher (p=0.042), and the ratio of tricuspid annular plane systolic excursion (TAPSE) to PASP (TAPSE/PASP) was lower (p=0.01) in LT or death group. In receiver operating characteristic analysis, the area under the curve was 0.759 (95% confidence interval 0.589-0.929) for TAPSE/PASP to predict primary outcome, and the optimal cut-off value was 0.30 mm/mmHg (sensitivity 0.875 and specificity 0.667). In a multivariate analysis, TAPSE/PASP was independently associated with death or LT. Kaplan-Meier analysis showed a better LT-free survival in patients with TAPSE/PASP 0.30 mm/mmHg than in those with<0.30 mm/mmHg (p=0.001). Low-level TAPSE/PASP could be a poor prognostic factor in PAH patients referred for LT evaluation.

Automated summary

Lung transplantation is the only option for patients with severe pulmonary arterial hypertension who do not respond to medical therapy. This study aimed to identify prognostic factors for severe PAH at the time of referral for transplantation evaluation. The results showed that a higher pulmonary arterial systolic pressure (PASP) and a lower ratio of tricuspid annular plane systolic excursion (TAPSE) to PASP (TAPSE/PASP) were associated with an increased risk of death or lung transplantation. The study suggests that a low TAPSE/PASP could be a poor prognostic factor in PAH patients referred for lung transplantation evaluation.