AIMS Pulmonary arterial hypertension (PAH) is a serious and devastating complication of systemic lupus erythematosus (SLE), especially when the right ventricle (RV) fails. Whether the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) measured by echocardiography as a simple surrogate of RV to pulmonary circulation (PC) coupling predicts the outcome of SLE-associated PAH has not been investigated. METHODS AND RESULTS Between February 2010 and August 2015, 112 consecutive patients with a diagnosis of SLE-associated PAH confirmed by right heart catheterization were enrolled prospectively. The endpoint was a composite of all-cause mortality and clinical worsening. Baseline clinical characteristics and echocardiographic assessment were analysed. Among all the patients, 47 (42%) patients experienced the endpoint (mean follow-up period 18.1 ± 12.0 months), including 20 patients who died during a median follow-up period of 48.5 months. Multivariable Cox regression analysis showed that TAPSE/PASP ratio [hazard ratio (HR) 0.004, P = 0.017] and 6-min walk distance (6MWD) (HR 0.997, P = 0.036) were the independent predictors for the endpoint. A three-group prediction risk was created based on combined assessment of the TAPSE/PASP ratio and 6MWD relative to their cut-off values. The patients with the worse RV-PC coupling (TAPSE/PASP <0.184 mm/mmHg) and the lower 6MWD (<395 m) had the highest risk (HR 4.62, confidence interval 2.27-9.41, P < 0.001) of experiencing the endpoint. CONCLUSION The TAPSE/PASP ratio, combined with 6MWD, provides clinical and prognostic insights into patients with SLE-associated PAH. A low TAPSE/PASP and low 6MWD identifies the subgroup of patients with high risk of poor prognosis.

中文翻译：

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无创性右心室对肺循环耦合在系统性红斑狼疮合并肺动脉高压的患者中的预测价值。

AIMS肺动脉高压（PAH）是系统性红斑狼疮（SLE）的严重破坏性并发症，尤其是在右心室（RV）衰竭时。通过超声心动图测量的三尖瓣环平面收缩偏移（TAPSE）与肺动脉收缩压（PASP）之间的比值是否可以作为RV与肺循环（PC）耦合的简单替代物，是否可以预测SLE相关PAH的结果。方法与结果2010年2月至2015年8月，前瞻性纳入了112例经右心导管检查确诊为SLE相关性PAH的患者。终点是全因死亡率和临床恶化的综合结果。分析基线临床特征和超声心动图评估。在所有病人中 47名（42％）患者经历了终点（平均随访期18.1±12.0个月），包括20名在中位随访期48.5个月内死亡的患者。多变量Cox回归分析表明，TAPSE / PASP比[危险比（HR）0.004，P = 0.017]和6分钟步行距离（6MWD）（HR 0.997，P = 0.036）是终点的独立预测因子。基于对TAPSE / PASP比值和6MWD相对于其临界值的组合评估，创建了三组预测风险。RV-PC耦合较差（TAPSE / PASP <0.184 mm / mmHg）和6MWD较低（<395 m）的患者发生终点的风险最高（HR 4.62，置信区间2.27-9.41，P <0.001） 。结论TAPSE / PASP比值与6MWD结合可为SLE相关PAH患者提供临床和预后方面的见识。