Introduction
Methods
Search strategy
Author | Year | Design | Included in meta-analysis | HF population | No. of patients | LVEF cut-off for inclusion, % | LVEF, % (mean) | Age, years, (mean) | Male, % | TAPSE/PASP, mm/mmHg (mean) | Vendor | Reproducibility for TAPSE/PASP |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Guazzi et al. [5] | 2013 | Prospective | Yes | HFrEF and HFpEF | 293 | - | 36.0 ± 11.1 | 62.9 ± 8.9 | 79.2 | 0.50 ± 0.15 | Phillips | Interobserver: coefficient of variation 3.5% (TAPSE), 4.7% (PASP); intraobserver: coefficient of variation 3% (TAPSE), 4% (PASP) |
Guazzi et al. [28] | 2015 | Prospective | No | HFrEF and HFpEF | 458 | - | 33.6 ± 10.6 | 62.5 ± 9.5 | 84.3 | 0.51 ± 0.17 | Phillips | Interobserver: coefficient of variation 3.5% (TAPSE), 4.7% and 4.3 (PASP) |
Iacoviello et al. [6] | 2017 | Retrospective | Yes | Stable HF, LVEF <45% | 315 | <45 | NA | 64.0 ±14.0 | 77.0 | 0.61 ± 0.23 | GE | NA |
Guazzi et al. [23] | 2017 | Prospective | No | HFpEF | 387 | ≥50 | 59.5 ± 6.8 | 65.1 ± 11.5 | 40.4 | NA | Phillips, GE | NA |
Ghio et al. [14] | 2017 | Retrospective | Yes | Ischaemic, hypertensive, idiopathic HFrEF and HFpEF | 1663 | - | NA | 65.0 ± 13.0 | 75.0 | NA | NA | NA |
Bosch et al. [20] | 2017 | Prospective | Yes | HFrEF and HFpEF | 438 | All | 45.0 ± 8.0 | 66.5 ± 11 | 50.7 | 0.55 ± 0.27 | NA | NA |
Gorter et al. [18] | 2018 | Prospective | Yes | HF with LVEF ≥45% and suspected pulmonary hypertension | 102 | ≥45 | 57.0 ± 5.0 | 73.4 ± 8.5 | 30.9 | 0.44 ± 0.20 | GE | NA |
Santas et al. [24] | 2019 | Prospective | No | Acute HFpEF | 760 | ≥50 | NA | 75.6 ± 9.7 | 31.7 | 0.43 ± 0.17 | Phillips | NA |
Falletta et al. [15] | 2019 | Prospective | Yes | Clinically stable HFrEF | 431 | ≤40 | 27.3 ± 5.7 | 59.0 ± 12.0 | 83.0 | NA | GE | NA |
Santas et al. [16] | 2020 | Prospective | Yes | Acute HFpEF | 884 | ≥50 | 61.7 ±7.5 | 76.1 ± 9.7 | 35.6 | 0.44 ± 0.17 | Phillips | NA |
Braganca et al. [19] | 2020 | Retrospective | Yes | HFrEF undergoing CRT | 70 | <35 | 26.4 ± 7.1 | 69.0 ± 9.0 | 68.6 | 0.48 ± 0.24 | Phillips | NA |
Rosa et al. [26] | 2020 | Retrospective | No | HFrEF and HFmrEF | 400 | ≤50 | 32.9 ± 8.5 | 77.5 ± 4.8 | 73.3 | 0.44 ± 0.33 | Mountain View, Phillips | NA |
Palazzuoli et al. [7] | 2020 | Prospective | No | Acute HFrEF and HFpEF | 381 | - | 45.0 ± 11.0 | 81.5 ± 9.0 | 42.0 | 0.43 ± 0.31 | NA | 95% reproducibility |
Schmeisser et al. [27] | 2021 | Prospective | No | HFrEF with indication for CRT | 330 | ≤35 | 31.6 ± 3.4 | 66.4 ± 4.6 | NA | 0.39 ± 0.16 | Phillips | NA |
Karam et al. [9] | 2021 | Retrospective | No | Secondary MR undergoing TMVR | 817 | - | 35.8 ± 13.1 | 73.8 ±10.1 | 66.3 | 0.46 ± 0.20 | NA | Interobserver: interclass correlation coefficient >0.85 |
Deaconu et al. [22] | 2021 | Prospective | Yes | HFrEF undergoing CRT | 54 | <35 | 28.4 ± 1.3 | 64.0 ± 13.8 | 58.0 | 0.70 ± 0.20 | NA | NA |
Ishiwata et al. [21] | 2021 | Retrospective | Yes | Dilated cardiomyopathy, HFrEF | 109 | <40 | 22.0 ± 7.4 | 44.1 ± 14.0 | 69.8 | 0.47 ± 0.22 | NA | NA |
Stassen et al. [8] | 2022 | Retrospective | Yes | HFrEF undergoing CRT | 807 | ≤35 | 27.8 ± 8.3 | 65.5 ± 10.5 | 76.0 | 0.46 ± 0.34 | GE | NA |
Study selection – eligibility criteria
Data extraction
Risk of bias assessment
Outcomes of interest
Data synthesis and statistical analysis
Results
Search outcomes
Qualitative analysis
Study characteristics
Prognostic value of TAPSE/PASP
Author | Year | Included in meta-analysis | HF population | Primary outcome | TAPSE/PASP cutoff value (mm/mmHg) | Follow up | Predictive value of TAPSE/PASP |
---|---|---|---|---|---|---|---|
Guazzi et al. [5] | 2013 | Yes | HFrEF andHFpEF | Cardiovascular mortality | 0.36 | 20 months (median) | TAPSE/PASP <0.36 was associated with worse event free survival |
Guazzi et al. [28] | 2015 | No | HFrEF and HFpEF | Composite of cardiovascular mortality, left ventricular assist device implant, or heart transplant | 0.40 | 4 years max | TAPSE/PASP <0.40 was associated with worse event free survival, Hazard ratio: 5.6 (3.5-8.9; p<0.001) |
Iacoviello et al. [6] | 2017 | Yes | Stable HF, LVEF <45% | All-cause mortality | NA | 36 months (range; 10-62) | After adjustment, TAPSE/PASP remained significantly associated with events in echocardiographic (HR: 0.69; 95% CI: 0.52–0.93; p: 0.016) but not in the clinical multivariate model (HR: 0.94; 95% CI: 0.71–1.25; p: 0.68) |
Guazzi et al. [23] | 2017 | No | HFpEF | All-cause death and any cardiovascular hospitalization | 0.35 | 13.4 months (range; 5.2-23.7) | Adverse outcomes were more common in the lower tertile (TAPSE/PASP <0.35) compared to the others |
Ghio et al. [14] | 2017 | Yes | HFrEF and HFpEF | All-cause mortality | 0.36 | 5 months (median) | Patients with TAPSE/PASP <0.36 and LVEF <40% demonstrated the worst long term event free survival |
Bosch et al. [20] | 2017 | Yes | HFrEF and HFpEF | All-cause mortality and HF hospitalization | 0.48 | 715 days (median) | Significant increase in the composite endpoint among patients with TAPSE/PASP <0.48 (log-rank p< 0.001) |
Gorter et al. [18] | 2018 | Yes | HF with LVEF ≥45% and suspected pulmonary hypertension | All cause mortality | 0.36 | 816 days (range; 547–1047) | TAPSE/PASP <0.36 was associated with worse event free survival (log-rank p=0.006) |
Santas et al. [24] | 2019 | No | Acute HFpEF | Hospitalization for any cause | 0.36 | 2 years (range; 0.74-3.6) | TAPSE/PASP <0.36 was associated with a higher risk of HF-related recurrent admissions (incidence rate ratio [IRR] 1.51, 95% CI, 1.01 to 2.24; p=0.040) |
Falletta et al. [15] | 2019 | Yes | Clinically stable HFrEF | All-cause mortality | 0.36 | 32 months (range; 20-53) | TAPSE/PASP ratio <0.36 had a threefold decrease in risk of death compared to the TAPSE/PASP ratio ≥0.36 group |
Santas et al. [16] | 2020 | Yes | Acute HFpEF | All-cause mortality | 0.36 | 1 year | The cohort with TAPSE/PASP <0.36 and significant tricuspid regurgitation had the highest cardiovascular mortality rates |
Braganca et al. [19] | 2020 | Yes | HFrEF undergoing CRT | All-cause mortality | 0.43 | 4 years (maximum) | No significant differences in survival were observed between groups with different RV-PA coupling (TAPSE/PASP <0.43 vs ≥0.43: four-year survival of 80% vs 76%, p=0.72) |
Rosa et al. [26] | 2020 | No | HFmrEF and HFrEF | All-cause mortality | 0.34 | 25.5months (range; 8-46) | Survival free from all-cause mortality in patients with TAPSE/PASP <0.34 was worse as compared to that of patients with TAPSE/PASP ≥0.34 (log-rank p<0.001) |
Palazzuoli et al. [7] | 2020 | No | Acute HFrEF and HFpEF | All-cause death and rehospitalization due to cardiovascular causes | 0.43 | 6 months | TAPSE/PASP ratio<0.43 was related to increased risk of the outcome in univariable (HR: 2.31; CI 1.54–3.46; p<0.001) but not in the multivariable analysis |
Schmeisser et al. [27] | 2021 | No | HFrEF with indication for CRT | All-cause mortality | 0.38 | 4.8 years (median) | Patients with TAPSE/PASP <0.38 had significantly worse overall survival |
Karam et al. [9] | 2021 | No | Functional MR undergoing TMVR with MitraClip | All-cause mortality | 0.27 | 476 days (range; 225-727) | Survival rates at 1 and 2 years were lower among patients with impaired RV-PA coupling; 70.2 vs. 84.0%, respectively; p<0.001; and 53.4% vs. 73.1%, respectively; p<0.001) |
Deaconu et al. [22] | 2021 | Yes | HFrEF undergoing CRT | All-cause mortality and HF rehospitalization | 0.58 | 31 months (range; 18.1-43.9) | TAPSE/PASP<0.58 was associated with a higher risk of death or HF hospitalizations (HR 5.37; 95% CI 1.6-18; p<0.001) |
Ishiwata et al. [21] | 2021 | Yes | Dilated cardiomyopathy, HFrEF | LV assist device implantation and all-cause death | - | 12 months | After adjusting for age, BMI, NYHA class, systolic blood pressure and heart rate, TAPSE/PASP was independently associated (HR: 0.19; CI 0.03-0.82; p=0.02) with the outcome |
Stassen et al. [8] | 2022 | Yes | HFrEFundergoint CRT | All-cause mortality | 0.45 | 97 months (range; 54-143) | Survival rates at 5 years follow-up were significantly lower for patients with a TAPSE/PASP ratio <0.45 compared to those with a TAPSE/PASP ratio ≥0.45 (58 vs 82%, p<0.001) |