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The tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio is an echocardiographic estimation of the right ventricle to pulmonary artery (RV/PA) coupling, with a validated prognostic role in different clinical settings. Systemic sclerosis (SSc) patients without evident cardiovascular involvement frequently display subtle RV impairment. The amino-terminal atrial natriuretic peptide (NT-proANP) plasma level relates to SSc disease progression and mortality. We aimed to assess the prognostic value of the TAPSE/sPAP ratio and its relationship with NT-proANP plasma level in SSc patients without overt cardiovascular involvement. We retrospectively analysed 70 SSc consecutive patients, with no clinical evidence of cardiovascular involvement or pulmonary hypertension (PH), and 30 healthy controls (HC) in a retrospective, single-centre study. All SSc patients underwent recurrent clinical and echocardiographic assessments and NT-proANP plasma level was assessed at baseline. SSc-related cardiovascular events and deaths were extracted during a 6-year follow-up. The complete work-up for the diagnosis, treatment and management of PH performed along the 6 years of follow-up referred to the 2015 European Society of Cardiology guidelines. Systemic sclerosis patients showed lower TAPSE/sPAP ratio at baseline compared to HC [SSc median value = 0.71 mm/mmHg, (IQR 0.62-0.88) vs. HC median value = 1.00 mm/mmHg, (IQR 0.96-1.05); < 0.001]. Multivariable Cox analysis revealed TAPSE/sPAP ratio as an independent predictor for SSc-related cardiovascular events [HR = 3.436 (95% CI 1.577-7.448); = 0.002] and mortality [HR = 3.653 (95% CI 1.712-8.892); = 0.014]. The value of TAPSE/sPAP ratio < 0.7 mm/mmHg was identified as an optimal cut-off for predicting adverse outcomes ( < 0.001) by receiver operating characteristic (ROC) analyses. NT-proANP level significantly related to TAPSE/sPAP ratio ( = < 0.001). TAPSE/sPAP ratio combined with NT-proANP showed an overall significant prognostic role in this SSc population, confirmed by Kaplan-Meier analysis (Log rank < 0.001). The TAPSE/sPAP ratio, as an index of RV/PA coupling, is an affordable predictor of cardiovascular events and mortality in SSc and, combined with NT-proANP level, may improve the clinical phenotyping and prognostic stratification of SSc patients.

Background Pulmonary arterial hypertension (PAH) is a life-threatening condition characterized by elevated pulmonary artery pressure and progressive right ventricular dysfunction. The ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/SPAP) has been proposed as a noninvasive marker integrating right ventricular function and afterload. This study aimed to evaluate the clinical and prognostic relevance of TAPSE/SPAP in patients with PAH. Methods and results This study was a retrospective analysis of 125 patients newly diagnosed with PAH at the Xiangya Second Hospital between 2016 and 2022. The patients were divided into two groups based on the median TAPSE/SPAP ratio: a low TAPSE/SPAP group and a high TAPSE/SPAP group. The primary outcome was survival and follow-up was conducted until December 2023. The results showed that a lower TAPSE/SPAP ratio (< 0.15 mm/mmHg) was significantly associated with worse survival outcomes, with a higher mortality rate in the low TAPSE/SPAP group (17/63, 27%) than in the high group (7/62, 11.3%). The low TAPSE/SPAP group also exhibited more severe right ventricular remodeling and worse hemodynamic parameters. A significant inverse correlation was found between TAPSE/SPAP and both World Health Organization functional class and NT-proBNP levels, suggesting its role in noninvasive risk stratification. Conclusion In this single-center retrospective cohort, a lower TAPSE/SPAP ratio was associated with more advanced disease and poorer outcomes in patients with PAH. Rather than serving as an independent prognostic predictor, TAPSE/SPAP may function as a composite, noninvasive marker reflecting right ventricular dysfunction and overall disease severity, and may be useful in clinical risk assessment when interpreted alongside established prognostic parameters.

Objectives The aim of the study was to evaluate the correlation between cardiopulmonary exercise testing (CPET) parameters and right ventricular echocardiographic parameters for pulmonary arterial hypertension screening in a cohort of systemic sclerosis (SSc) patients. Methods forty SSc patients were examined using CPET and resting transthoracic echocardiography. CPET parameters analyzed were minute ventilation/carbon dioxide production (VE/VCO 2 ) slope and maximum oxygen uptake (VO 2 max); echocardiographic parameters were systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/sPAP ratio. Results a positive correlation was observed between VE/VCO 2 slope and age ( r  = 0.415, p  < 0.01) and sPAP ( r  = 0.461, p  < 0.01), conversely, a negative correlation was found between VE/VCO 2 slope and TASPE/sPAP ratio ( r  = − 0.521, p  = 0.001). VO 2 max showed an inverse correlation with age ( r  = − 0.367, p  < 0.05) and sPAP ( r  = − 0.387, p  < 0.05) and a positive correlation with TAPSE/sPAP ratio ( r  = 0.521, p  < 0.01). On stepwise linear regression analysis, VE/VCO 2 slope was significantly correlated with TAPSE/sPAP ratio ( β coefficient = − 0.570; p  < 0.0001), as well as VO 2 max was significantly correlated with TAPSE/sPAP ratio ( β coefficient = 0.518; p  = 0.001). Conclusion in SSc patients, TAPSE/sPAP ratio is the echocardiographic parameter of RV function which showed the best correlation with ventilatory efficiency and exercise capacity.

Background Anthracycline-based chemotherapy agents are widely used and are highly effective, particularly for breast cancer treatment. Although the cardiotoxic effects of anthracyclines on left ventricular (LV) function are well established, their impact on right ventricular (RV) function has not been sufficiently investigated. This study aimed to evaluate the effects of anthracycline therapy on RV function and to compare them with LV function to determine the potential cardiotoxic effects on both ventricles. Methods This single-center retrospective cohort study included 38 female patients with breast cancer who were treated with anthracyclines between January 2021 and June 2023. Echocardiographic parameters and cardiac biomarkers were evaluated at baseline and at 6-month follow-up visit. LV ejection fraction (LVEF) was calculated using the Teichholz method due to the retrospective design. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio. Cancer therapy–related cardiac dysfunction (CTRCD) was defined according to current European Society of Cardiology criteria. Serum troponin I and pro–brain natriuretic peptide levels were recorded. Paired comparisons were performed using the paired-samples t-test. Results Following anthracycline therapy, LV end-systolic diameter increased (2.76 ± 0.24 cm vs. 3.03 ± 0.29 cm, P  < 0.001), and LVEF decreased (67.3% ± 3.6% vs. 62.2% ± 4.5%, P  < 0.001). No patient fulfilled the guideline-defined criteria for CTRCD. Early diastolic transmitral flow velocity (E wave) and mitral annular early diastolic velocity (e′) were reduced (E: 0.63 ± 0.16 m/sec vs. 0.52 ± 0.12 m/sec, P  < 0.001; e′: 0.09 ± 0.03 m/sec vs. 0.07 ± 0.02 m/sec, P  = 0.001). TAPSE decreased (2.28 ± 0.36 cm vs. 2.16 ± 0.27 cm, P  = 0.047), and systolic pulmonary artery pressure showed a nonsignificant upward trend after treatment ( P  = 0.052). The TAPSE/sPAP ratio declined (1.11 ± 0.47 vs. 0.86 ± 0.20, P  < 0.001), and pulmonary artery diameter increased (19.9 ± 2.0 mm vs. 21.3 ± 2.6 mm, P  = 0.008). Serum troponin I levels increased significantly (4.84 ± 1.25 ng/L vs. 11.93 ± 4.91 ng/L, P  < 0.001). Conclusions Anthracycline therapy may be associated with modest changes in both LV and RV parameters. Reductions in TAPSE and the TAPSE/sPAP ratio, together with a nonsignificant upward trend in systolic pulmonary artery pressure, may reflect subtle alterations in RV–pulmonary arterial interactions rather than overt RV dysfunction. Routine evaluation of RV function, alongside LV assessment, may provide additional insights during cardiotoxicity monitoring in anthracycline-treated patients. These findings should be interpreted cautiously and confirmed in larger prospective studies.

Malnutrition and systemic inflammation are increasingly recognized as important determinants of prognosis in patients with heart failure. Several immunonutritional indices, including the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, and the C-reactive protein-albumin-lymphocyte (CALLy) index, have been proposed as markers of nutritional and inflammatory status. However, their prognostic value in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely defined. This study aimed to evaluate the prognostic significance of these immunonutritional indices in elderly patients with HFpEF over a long-term follow-up period. This retrospective observational study included 200 elderly patients hospitalized with HFpEF (mean age 86.6 ± 6.5 years). Clinical, laboratory, and echocardiographic parameters were collected at admission. Nutritional status was assessed using PNI, CONUT score, and CALLy index. Patients were followed for mortality during long-term follow-up. Survival analyses were performed using Cox regression models, receiver operating characteristic (ROC) curves, and Kaplan-Meier analysis. Median follow-up was 3.8 years (IQR 2.1-5.9). During follow-up, 123 patients (61.5%) died, while 77 patients (38.5%) were alive at the end of observation. In univariate analysis, PNI, CONUT score, left ventricular ejection fraction (LVEF), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio were significantly associated with mortality. In multivariate analysis, the CONUT score, LVEF, and the TAPSE/sPAP ratio remained independent predictors of mortality. ROC analysis showed strong prognostic performance for the TAPSE/sPAP ratio (AUC 0.932), CONUT score (AUC 0.925), and LVEF (AUC 0.897). Optimal cut-off values for mortality prediction were CONUT ≥ 6, LVEF ≥ 65%, and TAPSE/sPAP ≤ 0.55 mm/mmHg. Kaplan-Meier analysis confirmed significantly reduced survival among patients with higher CONUT scores, higher LVEF, and an impaired TAPSE/sPAP ratio. In elderly patients with HFpEF, nutritional status and cardiopulmonary functional parameters are important determinants of long-term prognosis. The CONUT score emerged as the most informative immunonutritional index, while echocardiographic parameters reflecting ventricular function and right ventricular-pulmonary arterial coupling provided additional prognostic information. Integrating nutritional assessment with echocardiographic evaluation may improve risk stratification in elderly patients with HFpEF.

Objective: The study aims to investigate the use of pulmonary artery stiffness (PAS) parameter in early diagnosis of systemic sclerosis (SSc) and pulmonary hypertension in SSc patients.Patients and Methods: The study involved 102 SSc patients and 45 control group patients, who underwent transthoracic echocardiographic evaluations.Results: Pulmonary artery stiffness was measured as 25.7±7.6 (Hz/msn) in the SSc cases and 13.7 ±1.6 (Hz/msn) in the healthy subjects (P<0.001). TAPSE/sPAP ratio, which we used as an indicator of RV-PA coupling, was calculated as 0.65+0.28 in SSc cases and 1.12+0.33 in the control group (P<0.001).When we evaluated PAS values of subgroups PAS was significantly higher in SScPH(-) patients without pulmonary hypertension than control subjects (respectively; 21.67 ± 3.9; 13.7 ± 1.6, P<0.001). The relationship of PAS with the parameters in which pulmonary hypertension and right ventricular functions were evaluated, there was a positive correlation with sPAP( r: – 0.396, P <0.001), while a negative correlation was observed with TAPSE/sPAP (r: 0.456, P<0.001).Conclusion: We observed higher PAS values in SScPH(-) patients compared to the control group and found a positive correlation between the increase in PAS and sPAP and a negative correlation between them and TAPSE/sPAP.