Pos1243 the role of tapse/spap ratio in predicting pulmonary hypertension and mortality in the systemic sclerosis eustar cohort

Background Early pulmonary arterial hypertension (PAH) diagnosis and treatment are crucial to improve systemic sclerosis (SSc) patients’ outcomes. In PAH the progressive pulmonary vascular remodelling leads to an increasing load on the contracting RV and an altered right ventricular - pulmonary arterial (RV-PA) coupling. The RV-PA coupling describes the RV adaptation to its afterload [1]. Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio is the validated non-invasive estimation of RV-PA coupling [2]. In the new 2022 pulmonary hypertension (PH) guidelines, TAPSE/sPAP ratio has been included among the additional echocardiographic signs suggestive of PH and the echocardiographic parameters for 1-year mortality risk assessment [3]. However, to date, the role of TAPSE/sPAP ratio in SSc is underinvestigated [4-6]. Objectives The primary aim of the study was to assess the predictive role of TAPSE/sPAP ratio for PH diagnosis in the SSc European Scleroderma Trials and Research (EUSTAR) cohort. The secondary aim of the study was to evaluate the prognostic role of TAPSE/sPAP ratio in predicting mortality in the SSc EUSTAR cohort. Methods Eligible patients were systemic sclerosis (SSc) patients registered in the EUSTAR database with at least one visit recording TAPSE and sPAP data. Individual centres were required to provide TAPSE and sPAP data at 12 ± 3 months before right heart catheterization (RHC). Logistic regression analysis was applied to analyse the predictive ability of TAPSE/sPAP ratio for PH diagnosis. Cox regression analysis was performed to evaluate TAPSE/sPAP ratio as a predictive factor for all-cause mortality. Results 2555 SSc patients met the inclusion criteria for this study with 355 SSc patients having available RHC data at baseline. PH was confirmed by RHC in 195 SSc patients (54.9%). TAPSE/sPAP ratio <0.55 mm/mmHg [OR 0.251 (95% CI 0.084-0.753), p<0.05] and FVC/DLCO [OR 2.568 (95% CI 1.227-5.375), p<0.05] were significantly associated with PH diagnosis. In logistic regression analysis with echocardiographic parameters at 12±3 months before RHC, TAPSE/sPAP ratio <0.55 mm/mmHg [OR 0.265 (95% CI 0.102-0.685), p<0.01] and FVC/DLCO [OR 2.529 (95% CI 1.358-4.711), p<0.01] were significantly associated with PH diagnosis. In multivariate Cox regression analysis, TAPSE/sPAP ratio ≤0.32 mm/mmHg [HR 0.310 (0.164–0.585), p<0.001] was the most significant predictive factor for all-cause mortality. Conclusion TAPSE/sPAP ratio <0.55 mm/mmHg is a predictive risk factor for PH. TAPSE/sPAP ratio ≤0.32 mm/mmHg is a predictive risk marker for all-cause mortality. References [1]Vonk Noordegraaf A, Westerhof BE, Westerhof N. The relationship between the right ventricle and its load in pulmonary hypertension. J Am Coll Cardiol 2017;69:236–43. [2]Tello K M, Wan J, Dalmer A, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular–arterial coupling in severe pulmonary hypertension. Circ Cardiovasc Imaging 2019;12:e009047. [3]Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension [published online ahead of print, 2022 Aug 26]. Eur Heart J. 2022;ehac237. [4]Colalillo A, Grimaldi MC, Vaiarello V, et al. In systemic sclerosis, the TAPSE/SPAP ratio can be used in addition to the DETECT algorithm for pulmonary arterial hypertension diagnosis. Rheumatology (Oxford) 2022;61:2450-2456. [5]Lai J, Zhao J, Li K, et al. Right Ventricle to Pulmonary Artery Coupling Predicts the Risk Stratification in Patients With Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Front Cardiovasc Med 2022;9:872795. [6]Xanthouli P, Miazgowski J, Benjamin N, et al. Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis. Arthritis Res Ther 2022;24:173. Acknowledgements EUSTAR collaborators. Disclosure of Interests Amalia Colalillo: None declared, Anna-Maria Hoffmann-Vold: None declared, Chiara Pellicano: None declared, Antonella Romaniello: None declared, Armando Gabrielli: None declared, Eric Hachulla: None declared, Vanessa Smith: None declared, Carmen Pilar Simeon Aznar: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Janssen-Cilag, Genentech/Roche and Kern, Grant/research support from: Boehringer Ingelheim, Janssen-Cilag, Genentech/Roche and Kern, Paolo Airò Consultant of: Bristol Myers Squibb, Bohringer Ingelheim, and Novartis, Marie-Elise Truchetet: None declared, Elise Siegert: None declared, Oliver Distler: None declared, Edoardo Rosato: None declared.