LETTER TO THE EDITOR
Prognostic Value of the TAPSE/SPAP Ratio

Valor pronóstico de la relación TAPSE/PSAP

  • 1 Head of Heart Failure and Pulmonary Hypertension Section Hospital Churruca Visca.

Rev Argent Cardiol 2026;94:168-169. https://doi.org/10.7775/rac.v94.i2.20992

Correspondence: Lucrecia Secco. Email: Lucresecco@hotmail.com


2026©Revista Argentina de Cardiología

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The study by Freyre Hernando J et al., published in the latest issue of the Argentine Journal of Cardiology, (1) investigates the prognostic value of right ventricle (RV)-pulmonary artery (PA) uncoupling in patients with transthyretin cardiac amyloidosis (TTR-CA).

In this study, which analyzed 191 patients, the authors concluded that the tricuspid annulus plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (SPAP) ratio is an effective predictor of future hospital admissions for heart failure. A TAPSE/ SPAP ratio ≤ 0.5 is an independent predictor of risk, even in the presence of preserved ejection fraction (EF). This cut-off point of 0.5 was determined to be optimal due to its clinical balance, with a sensitivity of 78% and a specificity of 67% for predicting heart failure events. (1,2)

In contrast, other indicators, such as the S-wave on tissue Doppler imaging, did not provide relevant information for predicting disease progression. This is because the S'-wave on tissue Doppler may be more susceptible to noise artifacts, measurement angles and the involvement of the basal segments characteristic of amyloidosis, which limits its prognostic value in this disease. (3)

The TAPSE/SPAP ratio reflects the ability of the RV to adapt to pulmonary circulation, a phenomenon known as RV-PA coupling; it integrates the relationship between RV contractility and afterload into a single measurement. In TTR-CA, progressive stiffness compromises this adaptation, promoting ‘uncoupling’. (1,4)

One of the primary strengths of this study is its specificity in the TTR-CA population, unlike prior studies that used mixed populations with AL amyloidosis. Furthermore, this parameter stands out for its simplicity and clinical applicability. The TAPSE/SPAP ratio is a non-invasive, reproducible index that can be obtained using standard echocardiography equipment, which makes it easy to use. (1,5)

There are areas of opportunity that this study has not explored, which would be fundamental to consolidating this parameter. The incorporation of RV free wall strain could be valuable for obtaining a more precise measurement of deformation that is not dependent on the geometric limitations of TAPSE. (4)

In conclusion, the data provided by this article regarding the TAPSE/SPAP ratio identifies a practical threshold (≤ 0.5), which allows clinicians to identify high-risk patient subgroups at an early stage-something that other traditional markers do not achieve with the same precision in this specific population. (1,2).

Ethical considerations

Not applicable.

Conflicts of interest

None declared.

(See authors' conflict of interests forms on the web).

 
 

REFERENCES

1. Freyre Hernando J, Spaccavento A, Burgos L, Seia I, Sigal A, Elissamburu P, y cols.. Valor pronóstico del desacoplamiento ventrículo derecho-arteria pulmonar en la amiloidosis cardíaca por transtiretina. Rev Argent Cardiol 2026;94:48-56. https://doi.org/10.7775/rac.es.v94.i1.20969

2. Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E, et al.. Prognostic value of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in cardiac amyloidosis. Rev Esp Cardiol 2024;77:634-44. https://doi.org/10.1016/j.recesp.2024.01.0016.

3. De Gaspari M, Sinigiani G, De Michieli L, Della Barbera M, Rizzo S, Thiene G, et al.. Relative apical sparing in cardiac amyloidosis is not always explained by an amyloid gradient. Eur Heart J Cardiovasc Imaging 2023;24:1258-68. https://doi.org/10.1093/ehjci/jead10729.

4. De Groote P, Fertin M, Goéminne C, Petyt G, Peyrot S, Foucher-Hossein C, et al.. Right ventricular systolic function for risk stratification in patients with stable left ventricular systolic dysfunction: comparison of radionuclide angiography to echoDoppler parameters. Eur Heart J 2012;33:2672-9. https://doi.org/10.1093/eurheartj/ehs0807.

5. Naseem M, Alkassas A, Alaarag A. Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of in-hospital mortality for acute heart failure. BMC Cardiovasc Disord 2022;22:414. https://doi.org/10.1186/s12872022-02857-68.

AUTHORS’ REPLY

 

We would like to extend our special thanks to Dr Secco for her detailed analysis and for underscoring the clinical relevance of the TAPSE/SPAP ratio as a marker of right ventricular-pulmonary artery uncoupling in transthyretin cardiac amyloidosis.

We agree that this ratio represents a simple, noninvasive, widely available tool to integrate right ventricular contractility and its afterload into a single measurement, providing prognostic value even in patients with preserved ejection fraction.

Furthermore, we consider the observation regarding the possible inclusion of additional parameters, such as right ventricular free wall strain, to be highly pertinent, as these could complement the assessment and provide greater precision in future studies.

The aim of our work is to provide evidence in a specific population, such as that with TTR-CA, where the early identification of high-risk patients remains a significant clinical challenge.

We would like to thank you once again for your comments and for the opportunity to enrich the discussion on this topic.

Kind regards,

Jaqueline Freyre Hernando
On behalf of the authors

 
 

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