Abstract

Objective: Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) hypertrophy and failure. This study aims to evaluate the prognostic value of combining the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with right ventricular myocardial work (RVMW) parameters in patients with PAH, to improve early risk stratification. Methods: A total of 43 PAH patients diagnosed via right heart catheterization were enrolled. Echocardiography-derived TAPSE/sPAP ratio and RVMW parameters, including right ventricular global work efficiency (RVGWE), global work index (RVGWI), global constructive work (RVGCW), and global wasted work (RVGWW), were measured. Clinical worsening events were recorded during a median 515-day follow-up. Statistical analyses included correlation tests, Firth penalized logistic regression, receiver operating characteristic (ROC) curves, and Kaplan–Meier survival analysis. Results: The TAPSE/sPAP ratio correlated negatively with RVGCW (r = -0.346, p = 0.023) and RVGWW (r = -0.417, p = 0.005), but not with RVGWE or RVGWI. Clinical worsening events occurred in 25.6% of patients, with significantly lower TAPSE/sPAP ratio (0.16 vs. 0.24 mm/mmHg), RVGWE (72.0% vs. 88.5%), and RVGWI (431.0 vs. 641.0 mmHg%) in the Event group (all p < 0.05). Multivariate Firth penalized logistic regression was used for combining TAPSE/sPAP ratio with RVGWE. ROC analysis demonstrated that the combination of TAPSE/sPAP and RVGWE yielded superior predictive power (AUC = 0.949, p < 0.001) compared to individual parameters. Conclusion: Non-invasive assessment of TAPSE/sPAP ratio and RVGWE provides significant prognostic value in PAH. Their combination enhances early risk prediction, offering a practical tool for clinical management.

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