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Background <p>Residual pulmonary hypertension (RPH) is a major postoperative complication after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with worse recovery and prognosis. This study evaluated the predictive value of the preoperative tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling, for early RPH.</p> Methods <p>We retrospectively analyzed 183 consecutive patients with CTEPH who underwent PEA at a high-volume national center between December 2017 and September 2025. Early RPH was defined as a postoperative mean pulmonary artery pressure (mPAP) &gt; 30 mmHg. Independent predictors were identified using multivariable logistic regression. Predictive performance and model improvement were evaluated in the complete-case cohort using the area under the receiver operating characteristic curve (AUC), the likelihood ratio test, integrated discrimination improvement (IDI), and continuous net reclassification index (NRI). Internal validation was performed using 1,000 bootstrap resamples.</p> Results <p>Early RPH occurred in 48 patients (26.23%). Compared with the non-RPH group, patients with RPH had a lower preoperative TAPSE/sPAP ratio (0.21 ± 0.10 vs. 0.29 ± 0.15, <i>P</i> = 0.001), higher preoperative PVR (14.45 ± 5.39 vs. 10.16 ± 5.63 WU, <i>P</i> &lt; 0.001), and a higher RV/LV ratio (<i>P</i> &lt; 0.001). In multivariable analysis, preoperative PVR (OR 1.0010, <i>P</i> = 0.045) and the TAPSE/sPAP ratio (per 0.01-unit increase, OR 0.93, <i>P</i> = 0.046) were independently associated with early RPH. In the complete-case cohort (<i>n</i> = 151), the combined model including PVR and TAPSE/sPAP had an AUC of 0.753 (95% CI: 0.666–0.844), compared with 0.751 (95% CI: 0.664–0.830) for the PVR-only model. Although the increase in AUC was minimal (ΔAUC = +0.002, DeLong <i>P</i> = 0.940), the likelihood ratio test showed a significant improvement in model fit (<i>P</i> = 0.012). Reclassification analysis showed a positive integrated discrimination improvement (IDI = 0.034, <i>P</i> = 0.005), whereas the continuous net reclassification index showed only a numerical improvement (NRI = 0.297, <i>P</i> = 0.117). Internal validation showed a bias-corrected AUC of 0.724 and good calibration (Hosmer-Lemeshow test, <i>P</i> = 0.676; calibration slope = 0.92).</p> Conclusion <p>Preoperative PVR and the TAPSE/sPAP ratio were independently associated with early RPH after PEA. The TAPSE/sPAP ratio may offer complementary information for preoperative risk stratification when interpreted together with PVR.</p>

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Preoperative TAPSE/sPAP ratio predicts early residual pulmonary hypertension following pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

  • 期刊论文

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  • 发表日期：

    2026年6月22日

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  • Junyu Ma,
  • Dezhi Ren,
  • Yanan Zhen,
  • Aili Li,
  • Jun Duan

摘要

Background

Residual pulmonary hypertension (RPH) is a major postoperative complication after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with worse recovery and prognosis. This study evaluated the predictive value of the preoperative tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling, for early RPH.

Methods

We retrospectively analyzed 183 consecutive patients with CTEPH who underwent PEA at a high-volume national center between December 2017 and September 2025. Early RPH was defined as a postoperative mean pulmonary artery pressure (mPAP) > 30 mmHg. Independent predictors were identified using multivariable logistic regression. Predictive performance and model improvement were evaluated in the complete-case cohort using the area under the receiver operating characteristic curve (AUC), the likelihood ratio test, integrated discrimination improvement (IDI), and continuous net reclassification index (NRI). Internal validation was performed using 1,000 bootstrap resamples.

Results

Early RPH occurred in 48 patients (26.23%). Compared with the non-RPH group, patients with RPH had a lower preoperative TAPSE/sPAP ratio (0.21 ± 0.10 vs. 0.29 ± 0.15, P = 0.001), higher preoperative PVR (14.45 ± 5.39 vs. 10.16 ± 5.63 WU, P < 0.001), and a higher RV/LV ratio (P < 0.001). In multivariable analysis, preoperative PVR (OR 1.0010, P = 0.045) and the TAPSE/sPAP ratio (per 0.01-unit increase, OR 0.93, P = 0.046) were independently associated with early RPH. In the complete-case cohort (n = 151), the combined model including PVR and TAPSE/sPAP had an AUC of 0.753 (95% CI: 0.666–0.844), compared with 0.751 (95% CI: 0.664–0.830) for the PVR-only model. Although the increase in AUC was minimal (ΔAUC = +0.002, DeLong P = 0.940), the likelihood ratio test showed a significant improvement in model fit (P = 0.012). Reclassification analysis showed a positive integrated discrimination improvement (IDI = 0.034, P = 0.005), whereas the continuous net reclassification index showed only a numerical improvement (NRI = 0.297, P = 0.117). Internal validation showed a bias-corrected AUC of 0.724 and good calibration (Hosmer-Lemeshow test, P = 0.676; calibration slope = 0.92).

Conclusion

Preoperative PVR and the TAPSE/sPAP ratio were independently associated with early RPH after PEA. The TAPSE/sPAP ratio may offer complementary information for preoperative risk stratification when interpreted together with PVR.