Tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio in Hypertrophic cardiomyopathy

Background: The prognostic relevance of the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio in patients with hypertrophic cardiomyopathy (HCM) remains poorly investigated. We assess the prognostic value of the right ventricle-to-pulmonary artery (RV-PA) coupling in patients with HCM using the TAPSE/PASP ratio. Methods: Data were retrieved from a single-center prospective ongoing registry (NCT06898307) enrolling patients with cardiomyopathies followed at the cardiology clinic of the University of Ferrara, Italy. For this analysis, we retrospectively evaluated patients diagnosed with HCM from January 2019 to December 2024. The RV-PA coupling was evaluated by using the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. Results: Overall, 216 patients with HCM (mean age was 60.2 years ±7.6 years, 57.8 % males) were included into the analysis. Receiver operating characteristic curve analysis identified 0.46 mm/mmHg as the optimal cut-off for predicting the composite outcome of cardiovascular (CV) death and heart failure hospitalization (HFH). A TAPSE/PASP ratio < 0.45 mm/mmHg was independently associated with an approximately two-fold increased risk of the composite outcome of CV death, HFH, and arrhythmic events [Hazard ratio -HR-: 1.82, 95 % CI: 1.32–2.38; p < 0.001], as well as a significantly increased risk of HFH when considered separately [HR: 1.78, 95 % CI: 1.30–3.56; p = 0.001]. No significant association was observed between the TAPSE/PASP ratio and CV death or new arrhythmic events when analyzed as isolated outcomes. Conclusion: A TAPSE/PASP ratio < 0.45 mm/mmHg independently predicts an increased risk of the composite outcome of CV death, HFH, and arrhythmic events, as well as HFH alone, with approximately a two-fold elevated risk in patients with lower values.