{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:49:07Z","timestamp":1792446547019,"version":"4.5.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peak oxygen consumption (VO\u2082) is a key determinant of heart transplant eligibility in advanced heart failure (HF), reflecting integrated cardiopulmonary performance and long-term prognosis. We aimed to evaluate the association between the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE\/PASP) ratio\u2014a non-invasive marker of right ventricular\u2013pulmonary arterial (RV\u2013PA) coupling\u2014and exercise capacity, as measured by peak VO\u2082, in heart transplant candidates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 384 consecutive patients with advanced HF listed for heart transplantation between 2021 and 2023. All underwent transthoracic echocardiography, cardiopulmonary exercise testing (CPET), and right heart catheterization (RHC). Patients with LVEF &amp;gt;25%, severe pulmonary disease, or contraindications to CPET\/RHC were excluded. Participants were stratified into tertiles by TAPSE\/PASP ratio. A directed acyclic graph (DAG) guided confounder selection for multivariable linear regression assessing the association between TAPSE\/PASP and peak VO\u2082. Cox proportional hazards models evaluated the relationship between TAPSE\/PASP and a composite endpoint of death, left ventricular assist device implantation, or transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the patients was 50\u2009\u00b1\u200911 years; 14% were female. Higher TAPSE\/PASP tertiles were associated with longer exercise duration, higher peak VO\u2082, and better ventilatory efficiency. In adjusted regression analysis, TAPSE\/PASP was strongly associated with peak VO\u2082 (effect size: 6.7; 95% CI: 5.1\u20138.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Over a median follow-up of 865 days, higher TAPSE\/PASP was independently associated with lower event rates, with an adjusted hazard ratio of 0.78 (95% CI: 0.68\u20130.90;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) per 0.1-unit increase in TAPSE\/PASP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TAPSE\/PASP, beyond its role as a surrogate of RV function, is strongly associated with exercise capacity and, in secondary analyses, with long-term outcomes in advanced HF. Incorporating TAPSE\/PASP into transplant evaluation protocols may enhance risk stratification and help identify patients who require closer monitoring and tailored management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1686578","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:05:38Z","timestamp":1769000738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between the TAPSE\/PASP ratio and exercise capacity in heart transplant candidates with advanced heart failure"],"prefix":"10.3389","volume":"12","author":[{"given":"Rezzan Deniz","family":"Acar","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Karacam","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bitlis State Hospital","place":["Bitlis, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seda","family":"Tanyeri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azmican","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barkin","family":"Kultursay","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tunceli State Hospital","place":["Tunceli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suleyman Cagan","family":"Efe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulumser","family":"Sevgin Halil","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozgur Yasar","family":"Akbal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cem","family":"Dogan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Kaan","family":"Kirali","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kartal Kosuyolu Research and Education Hospital","place":["\u0130stanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.pcad.2024.01.012","article-title":"Modern advances in heart transplantation","volume":"82","author":"Srivastava","year":"2024","journal-title":"Prog Cardiovasc 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