{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:35:42Z","timestamp":1791556542137,"version":"4.3.4"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The main aim of this study was to assess the prognostic utility of TAPSE\/PASP as an echocardiographic parameter of maladaptive RV remodeling in cardiomyopathy patients using cardiac magnetic resonance (CMR) imaging. Furthermore, we sought to compare TAPSE\/PASP to TAPSE. The association of the echocardiographic parameters TAPSE\/PASP and TAPSE with CMR parameters of RV and LV remodeling was evaluated in 111 patients with ischemic and non-ischemic cardiomyopathy and cut-off values for maladaptive RV remodeling were defined. In a second step, the prognostic value of TAPSE\/PASP and its cut-off value were analyzed regarding mortality in a validation cohort consisting of 221 patients with ischemic and non-ischemic cardiomyopathy. A low TAPSE\/PASP (&lt;0.38 mm\/mmHg) and TAPSE (&lt;16 mm) were associated with a lower RVEF and a long-axis RV global longitudinal strain (GLS) as well as higher RVESVI, RVEDVI and NT-proBNP. A low TAPSE\/PASP, but not TAPSE, was associated with a lower LVEF and long-axis LV GLS, and a higher LVESVI, LVEDVI and T1 relaxation time at the interventricular septum and the RV insertion points. Furthermore, in the validation cohort, low TAPSE\/PASP was associated with a higher mortality and TAPSE\/PASP was an independent predictor of mortality. TAPSE\/PASP is a predictor of maladaptive RV and LV remodeling associated with poor outcomes in cardiomyopathy patients.<\/jats:p>","DOI":"10.3390\/diagnostics11122188","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T01:49:58Z","timestamp":1638150598000},"page":"2188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Application and Validation of the Tricuspid Annular Plane Systolic Excursion\/Systolic Pulmonary Artery Pressure Ratio in Patients with Ischemic and Non-Ischemic Cardiomyopathy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4379-4424","authenticated-orcid":false,"given":"Stanislav","family":"Keranov","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Haen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Vietheer","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebke","family":"Rutsatz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Sebastian","family":"Wolter","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen D.","family":"Kriechbaum","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"},{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"von Jeinsen","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6036-8689","authenticated-orcid":false,"given":"Pascal","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khodr","family":"Tello","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-6956","authenticated-orcid":false,"given":"Oliver","family":"D\u00f6rr","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas J.","family":"Rieth","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Nef","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian W.","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"},{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Liebetrau","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"},{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"},{"name":"Cardioangiological Center Bethanien (CCB), 60389 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Rolf","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0895-6491","authenticated-orcid":false,"given":"Till","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, 61231 Bad Nauheim, Germany"},{"name":"Kerckhoff Heart and Thorax Center, Department of Cardiology, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1093\/eurjhf\/hfs208","article-title":"Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure","volume":"15","author":"Ghio","year":"2013","journal-title":"Eur. J. Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S0735-1097(00)01102-5","article-title":"Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure","volume":"37","author":"Ghio","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1093\/cvr\/cvx145","article-title":"RV pressure overload: From hypertrophy to failure","volume":"113","author":"Tedford","year":"2017","journal-title":"Cardiovasc. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.amjcard.2015.10.033","article-title":"Right Ventricular Ejection Fraction in Ischemic Versus Nonischemic Cardiomyopathy","volume":"117","author":"Wasemiller","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ahj.2003.10.005","article-title":"Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance","volume":"147","author":"Grothues","year":"2004","journal-title":"Am. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/jmri.21407","article-title":"Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles","volume":"28","author":"Mooij","year":"2008","journal-title":"J. Magn. Reson. Imaging JMRI"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1164\/rccm.201611-2365OC","article-title":"Magnetic Resonance Imaging in the Prognostic Evaluation of Patients with Pulmonary Arterial Hypertension","volume":"196","author":"Swift","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1801900","DOI":"10.1183\/13993003.01900-2018","article-title":"Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: An update","volume":"53","author":"Chin","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_9","first-page":"232","article-title":"Right ventricular function in dilated cardiomyopathy and ischemic heart disease: Assessment with non-invasive imaging","volume":"23","author":"Schalla","year":"2015","journal-title":"Neth. Heart J. Mon. J. Neth. Soc. Cardiol. Neth. Heart Found."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/S0735-1097(02)01804-1","article-title":"Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction","volume":"39","author":"Zornoff","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1161\/CIRCULATIONAHA.113.002518","article-title":"The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy","volume":"128","author":"Gulati","year":"2013","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1161\/CIRCULATIONAHA.116.022339","article-title":"Predictors and Prognostic Significance of Right Ventricular Ejection Fraction in Patients with Ischemic Cardiomyopathy","volume":"134","author":"Sabe","year":"2016","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/eurjhf\/hfq161","article-title":"Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure","volume":"13","author":"Bourantas","year":"2011","journal-title":"Eur. J. Heart Fail."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1002\/ejhf.873","article-title":"Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction","volume":"19","author":"Bosch","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"H1373","DOI":"10.1152\/ajpheart.00157.2013","article-title":"Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: An index of right ventricular contractile function and prognosis","volume":"305","author":"Guazzi","year":"2013","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.jcmg.2016.12.024","article-title":"RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction: Stratification of Clinical Phenotypes and Outcomes","volume":"10","author":"Guazzi","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12933-020-01080-x","article-title":"The adipokine fatty-acid binding protein 4 and cardiac remodeling","volume":"19","author":"Ritzen","year":"2020","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1177\/2047487319868034","article-title":"Prognostic performance of the ESC SCORE and its German recalibrated versions in primary and secondary prevention","volume":"27","author":"Elsner","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jcmg.2015.12.001","article-title":"T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure","volume":"9","author":"Puntmann","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1161\/CIRCIMAGING.113.000553","article-title":"Is MRI the preferred method for evaluating right ventricular size and function in patients with congenital heart disease?: MRI is the preferred method for evaluating right ventricular size and function in patients with congenital heart disease","volume":"7","author":"Geva","year":"2014","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1111\/echo.14877","article-title":"Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function","volume":"37","author":"Agasthi","year":"2020","journal-title":"Echocardiography"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10554-004-1097-7","article-title":"Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: Accuracy, reproducibility and coherence study","volume":"20","author":"Beygui","year":"2004","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.jacc.2006.10.056","article-title":"Right ventricular dysfunction assessed by cardiovascular magnetic resonance imaging predicts poor prognosis late after myocardial infarction","volume":"49","author":"Larose","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1016\/j.jacc.2011.06.068","article-title":"Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy","volume":"58","author":"Kind","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1161\/CIRCIMAGING.113.000338","article-title":"Prognostic value of cardiovascular magnetic resonance imaging measurements corrected for age and sex in idiopathic pulmonary arterial hypertension","volume":"7","author":"Swift","year":"2014","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1183\/09031936.00158014","article-title":"Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension","volume":"45","author":"Swift","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1093\/ehjci\/jeaa285","article-title":"Pressure-volume loop validation of TAPSE\/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension","volume":"22","author":"Schmeisser","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/ejhf.664","article-title":"Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction","volume":"19","author":"Ghio","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e009047","DOI":"10.1161\/CIRCIMAGING.119.009047","article-title":"Validation of the Tricuspid Annular Plane Systolic Excursion\/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension","volume":"12","author":"Tello","year":"2019","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ijcard.2018.01.053","article-title":"Relevance of the TAPSE\/PASP ratio in pulmonary arterial hypertension","volume":"266","author":"Tello","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1532-429X-14-11","article-title":"Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension","volume":"14","author":"Freed","year":"2012","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1165\/rcmb.2010-0412OC","article-title":"Molecular signature of a right heart failure program in chronic severe pulmonary hypertension","volume":"45","author":"Drake","year":"2011","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1093\/cvr\/cvx146","article-title":"Fibroblasts and the extracellular matrix in right ventricular disease","volume":"113","author":"Frangogiannis","year":"2017","journal-title":"Cardiovasc. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1161\/CIRCULATIONAHA.113.001873","article-title":"Right ventricular diastolic impairment in patients with pulmonary arterial hypertension","volume":"128","author":"Rain","year":"2013","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1183\/09031936.00156714","article-title":"Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension","volume":"45","author":"Trip","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jcmg.2014.08.012","article-title":"Association of myocardial T1-mapping CMR with hemodynamics and RV performance in pulmonary hypertension","volume":"8","author":"Pereda","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1161\/CIRCULATIONAHA.118.035326","article-title":"Right Ventricular Fibrosis","volume":"139","author":"Andersen","year":"2019","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1007\/s00330-016-4585-y","article-title":"Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension","volume":"27","author":"Roller","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_40","first-page":"177","article-title":"2015 ESC\/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension","volume":"69","author":"Humbert","year":"2016","journal-title":"Rev. Esp. Cardiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/12\/2188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:35:26Z","timestamp":1760168126000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/12\/2188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["diagnostics11122188"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11122188","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}