Evidence map›Paper›PMID 42252485›Full record

ArticleEcho research and practice2026

Significance of echocardiographic metrics including TRV and TAPSE/SPAP in mild haemodynamic pulmonary hypertension - data from EVIDENCE-PAH UK.

Nina Karia, Daniel Murphy, Luke Howard, Martin Johnson, David G Kiely, James Lordan, Colm McCabe, Joanna Pepke-Zaba, Daniel Knight, Vivek Muthurangu and 1 more

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Article in Echo research and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

11 authors.

Nina Karia *National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
Daniel Murphy *National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
Luke HowardNational Pulmonary Hypertension Service, Hammersmith Hospital, London, W12 0HS, UK.
Martin JohnsonScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK.
David G KielySheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.
James LordanPulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
Colm McCabeNational Pulmonary Hypertension Service, Royal Brompton Hospital, London, SW3 6NP, UK.
Joanna Pepke-ZabaPulmonary Vascular Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, CB2 0AY, UK.
Daniel KnightNational Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
Vivek Muthurangu *Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK.
J Gerry Coghlan *National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. Gerry.coghlan@nhs.net.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe 2022 ESC/ERS guidelines redefined pulmonary hypertension (PH) as a mean pulmonary artery pressure (mPAP) >20 mmHg on right heart catheterisation (RHC). Echocardiography, using metrics such as tricuspid regurgitation velocity (TRV), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/systolic pulmonary artery pressure (TAPSE/SPAP), guides referral for RHC. However, the few studies evaluating echocardiographic performance using the ESC/ERS 2022 thresholds have combined the newly included population as a relatively modest subgroup within their overall analysis.

resultsWe present a sample of 1,991 individuals from the EVIDENCE-PAH UK database. Our data demonstrate higher TRV and sPAP values and lower TAPSE/SPAP values with higher haemodynamic category. ROC analysis demonstrates that TRV, SPAP and TAPSE/SPAP perform well as predictors of mPAP > 20 mmHg and ≥25 mmHg (AUCs 0.785-0.830), but less well at predictive mPAP 21-24 mmHg (AUCs 0.656-0.686). In all PH patients and the mild PH (21-24 mmHg) subgroup, TAPSE/SPAP < 0.31 mm/mmHg predicted reduced survival (HR 2.01-3.14, p < 0.001). Similarly, in haemodynamically mild PH, TRV > 3.4 m/s was associated with worse survival compared to TRV < 2.5 m/s or 2.5-2.8 m/s (p < 0.001).

conclusionsWhile established echocardiographic metrics (TRV, TAPSE/SPAP) are strong predictors of significant PH (mPAP ≥25 mmHg), they are less accurate for mild PH (mPAP 21-24 mmHg). Importantly, mild PH itself is associated with increased mortality, and within this group, TRV >3.4 m/s and TAPSE/SPAP <0.31 mm/mmHg identify patients at highest risk, supporting their prognostic utility even in early haemodynamic disease.

Indexed as

Mild elevations of pulmonary artery pressurePrognosisPulmonary hypertensionRight heartTricuspid annular plane systolic excursion (TAPSE)Tricuspid regurgitation velocity (TRV)

Identifiers

PMID42252485
PMCPMC13245079

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