A low ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) is predictive of poorer prognosis in patients with pulmonary arterial hypertension (PAH) undergoing evaluations for lung transplantation suitability, according to a study published in Scientific Reports.

The authors of this study conducted a retrospective investigation into the predictive value of various clinical parameters upon patient referral for lung transplantation. The research team analyzed the clinical records of 34 patients with PAH referred for lung transplantation at the University of Tokyo Hospital in Japan between May 2014 and June 2020. They then analyzed available hemodynamic and echocardiographic data to identify factors that contribute to a poorer prognosis. 

The researchers discovered through statistical analysis that the TAPSE/PASP ratio was significantly associated with lung transplantation (the last-resort therapeutic option in PAH) or death. The authors of this study reported that the TAPSE/PASP ratio was highly sensitive and specific in its predictive value of death or the need for lung transplantation. 

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The findings of this study highlight the importance of carrying out echocardiographic assessments of patients’ TAPSE/PASP ratio when optimizing medical therapy and deciding individual suitability for lung transplantation. 

Read more about PAH etiology

Despite advancements in PAH therapeutics in recent years, patients who remain refractory to maximal targeted therapy have reduced survival. In these circumstances, lung transplantation is the only curative option. 

There are strict criteria for patients with PAH who are referred for lung transplantation. For example, they must demonstrate poor World Health Organization (WHO) functional class, have a 6-minute walk distance of less than 350 m, and possess signs of right heart failure. Even if a patient qualifies for lung transplantation, the waiting list is often long. 

“Hence, there is an unmet need for establishing a straightforward prognostic clinical index for clinical predictions about patients with severe PAH, who are deteriorating under combination therapy,” the authors of this study wrote. 


Ishii S, Minatsuki S, Hatano M, et al. The ratio of TAPSE to PASP predicts prognosis in lung transplant candidates with pulmonary arterial hypertensionSci Rep. 2023;13(1):3758. doi:10.1038/s41598-023-30924-1