title: Prognostic value of TAPSE after therapy optimisation in patients with pulmonary arterial hypertension is independent of the haemodynamic effects of therapy.
abstract: To evaluate the prognostic significance of right ventricular function assessed by echocardiography after start or escalation of targeted therapy in patients with pulmonary arterial hypertension.
  
  
  
  
  
  
  
  longitudinal study.
  
  
  
  tertiary referral centre for pulmonary hypertension.
  
  
  
  81 consecutive patients with pulmonary arterial hypertension (33 naive and 48 prevalent).
  
  
  
  right heart catheterisation and echocardiography performed prior to starting or escalating targeted therapy and repeated in 55 patients after 4-12 months of therapy.
  
  
  
  survival after follow-up examinations.
  
  
  
  11 patients died and 7 were lost to follow-up during the first year; 8 patients underwent first follow-up evaluation beyond 1 year. 55 patients were re-evaluated after therapy; during the subsequent follow-up period of 25 months, 9 patients died, 7 worsened from WHO I/II to III/IV and 15 remained in WHO III/IV despite therapy. A baseline tricuspid annular plane systolic excursion (TAPSE) ≥15 mm was associated with a lower risk of death (HR=0.32; 95% CI 0.12 to 0.83, p=0.012). Attaining a TAPSE≥15 mm after therapy was associated with a significantly lower risk of death or clinical worsening (HR=0.2; 95% CI 0.1 to 0.6, p=0.002) and a lower risk of death which approached statistical significance (HR=0.3; 95% CI 0.2 to 1.1, p=0.075). Per cent changes in TAPSE were loosely related to changes in pulmonary vascular resistances after therapy (R=0.37).
  
  
  
  In patients with pulmonary arterial hypertension, the evaluation of right ventricular function by TAPSE after targeted therapy is useful to predict subsequent prognosis, regardless of the haemodynamic effects of therapy.
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pica
authors.affiliation: Department of Biometry and Clinical Epidemiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Guzzafame
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Scelsi
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Turco
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Schirinzi
authors.affiliation: Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Luigi Oltrona
authors.initials: LO
authors.lastname: Visconti
keywords: Cardiac imaging and diagnostics