Heart scan metric may better gauge impact of daily PAH symptoms
TAPSE/sPAP ratio offers noninvasive way to track physical limits in patients
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A noninvasive measure of heart and blood vessel function called the TAPSE/sPAP ratio can help doctors objectively assess the severity of day-to-day symptoms in people with pulmonary arterial hypertension (PAH), according to a new study.
Researchers found that lower ratio values closely mirror greater physical limitations in patients, providing a reliable tool for tracking disease burden alongside patient-reported symptoms.
The tool pairs two key measurements: TAPSE, which tracks right ventricular health, and sPAP, which measures pulmonary artery pressure. Together, they provide a clearer snapshot of overall heart and lung function during routine clinic evaluations.
“These findings support the use of TAPSE/sPAP as an objective [imaging measure] complement to symptom-based functional assessment within [clinical] evaluation of patients with PAH,” scientists wrote.
The study, “The TAPSE/sPAP ratio as an objective echocardiographic correlate of functional impairment in pulmonary arterial hypertension: a retrospective cross-sectional study,” was published in BMC Pulmonary Medicine.
Measuring disease impact and heart health
PAH is characterized by abnormally high pressure in the pulmonary arteries, the vessels that carry blood from the heart through the lungs. This pressure strains the right ventricle, the part of the heart responsible for pumping blood to the lungs.
PAH symptoms can include difficulty breathing and chest pain. The disease’s impact is commonly tracked using the World Health Organization functional class (WHO-FC) system. This divides patients into four classes based on how much symptoms hinder daily activities:
- Class I (no limitations)
- Class II (mild limitations)
- Class III (moderate limitations)
- Class IV (severe limitations, with symptoms present even at rest)
The TAPSE/sPAP ratio evaluates the relationship between two imaging measures:
- TAPSE (tricuspid annular plane systolic excursion), which is a marker of right ventricular health
- sPAP (systolic pulmonary arterial pressure, also sometimes abbreviated PASP), a marker of pressure in the pulmonary artery
Previous studies showed that the TAPSE/sPAP ratio can serve as an objective measure to track disease severity and inform clinical decisions, such as prioritizing patients for lung transplantation. In the new study, researchers in Turkey sought to determine whether a link exists between the TAPSE/sPAP ratio and daily symptom severity under the WHO-FC system.
They also set out “to determine whether the TAPSE/sPAP ratio represents an objective [imaging-based measurement] of functional impairment.”
The study included data from 150 people with PAH. Using statistical analyses, the researchers found a significant negative correlation between WHO-FC class and TAPSE/sPAP ratio. Put simply, patients with higher WHO-FC classes (indicating greater impairment) tended to have lower TAPSE/sPAP ratios. Among Class I patients without impairment, the median TAPSE/sPAP ratio was 0.75 mm/mmHg, compared with 0.25 mm/mmHg in Class IV patients with severe symptoms.
“The principal finding of this study is that the TAPSE/sPAP ratio, calculated from standard [imaging], showed a progressive decline across WHO-FC in patients with PAH,” the researchers concluded.
These data suggest that TAPSE/sPAP may serve as a useful objective measure for tracking PAH severity, the researchers wrote. In statistical tests, they found that a cut-off of 0.31 mm/mmHg accurately identified 64.4% of patients with Class III or Class IV PAH and 96.7% of patients with less impairment.
The researchers noted that their analysis was limited to patients at one center who were assessed at a single point in time and highlighted the need for larger studies to track how TAPSE/sPAP and PAH symptoms change over time.
“Prospective multicentre studies with longitudinal follow-up and serial TAPSE/sPAP assessment are needed to determine whether temporal changes in [TAPSE/sPAP] parallel changes in functional status and clinical outcomes across diverse PAH populations,” the scientists wrote.
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