Clinical relevance of the TAPSE/SPAP ratio in pulmonary arterial hypertension: a single-center retrospective study

Pulmonary arterial hypertension (PAH) is a life-threatening condition characterized by elevated pulmonary artery pressure and progressive right ventricular dysfunction. The ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/SPAP) has been proposed as a noninvasive marker integrating right ventricular function and afterload. This study aimed to evaluate the clinical and prognostic relevance of TAPSE/SPAP in patients with PAH. This study was a retrospective analysis of 125 patients newly diagnosed with PAH at the Xiangya Second Hospital between 2016 and 2022. The patients were divided into two groups based on the median TAPSE/SPAP ratio: a low TAPSE/SPAP group and a high TAPSE/SPAP group. The primary outcome was survival and follow-up was conducted until December 2023. The results showed that a lower TAPSE/SPAP ratio (< 0.15 mm/mmHg) was significantly associated with worse survival outcomes, with a higher mortality rate in the low TAPSE/SPAP group (17/63, 27%) than in the high group (7/62, 11.3%). The low TAPSE/SPAP group also exhibited more severe right ventricular remodeling and worse hemodynamic parameters. A significant inverse correlation was found between TAPSE/SPAP and both World Health Organization functional class and NT-proBNP levels, suggesting its role in noninvasive risk stratification. In this single-center retrospective cohort, a lower TAPSE/SPAP ratio was associated with more advanced disease and poorer outcomes in patients with PAH. Rather than serving as an independent prognostic predictor, TAPSE/SPAP may function as a composite, noninvasive marker reflecting right ventricular dysfunction and overall disease severity, and may be useful in clinical risk assessment when interpreted alongside established prognostic parameters.