Prognostic Value of Echocardiographic TAPSE/PASP Ratio-Defined RV-PA Uncoupling in Cardiovascular and NonCardiovascular Diseases.

BACKGROUND

Right ventricular-pulmonary arterial uncoupling (RV-PAuc), assessed by the tricuspid annular plane systolic excursion-to-pulmonary artery systolic pressure (TAPSE/PASP) ratio, acts importantly to determine outcomes in both cardiovascular diseases (CVDs) and non-CVDs.

OBJECTIVES

This study sought to evaluate the prognostic value of the TAPSE/PASP ratio across diseases, identify RV-PAuc-related risk factors, and explore an optimal cutoff for risk stratification and clinical application.

METHODS

Two independent reviewers selected eligible studies, including 82 cohort studies with 32,482 patients for mortality endpoints and 17 observational studies with 4,615 participants for baseline TAPSE/PASP values for this meta-analysis (PROSPERO, CRD42024579107). Relative risk (RR) was calculated for mortality endpoints, and standard mean differences were used for comparisons.

RESULTS

RV-PAuc was positively associated with mortality in both CADs and non-CADs (RR: 2.20 [95% CI: 2.02-2.40]; I2 = 81.6%]. Cutoff values ranged from 0.15 to 0.70 across conditions: pulmonary arterial hypertension (0.15-0.33), valvular heart disease (0.27-0.55), heart failure (0.33-0.60), cardiac amyloidosis (0.31-0.47), acute coronary syndrome (0.49-0.55), sepsis (0.39-0.50), COVID-19 (0.50-0.64), and other non-CVDs (0.63-0.70). The association remained significant at the 3 most commonly used cutoffs (0.31, 0.36, and 0.50), with heterogeneity eliminated only at 0.50. Except for body mass index, hypertension, and dyslipidemia, factors such as age (0.43-0.67), estimated glomerular filtration rate (0.31-0.60), atrial fibrillation (0.27-0.60), chronic kidney disease (0.34-0.40), coronary artery disease (0.27-0.37), type 2 diabetes (0.40-0.51), stroke, and chronic obstructive pulmonary disease were associated with RV-PAuc, with observed heterogeneity in TAPSE/PASP cutoff values.

CONCLUSIONS

The TAPSE/PASP ratio is a potential prognostic marker for predicting mortality in CVDs and non-CVDs. Despite heterogeneity, a universal cutoff of ≤0.50 mm/mm Hg enhances its clinical applicability.