The prognostic significance of tricuspid valve regurgitation in pulmonary arterial hypertension
The Clinical Respiratory Journal Sep 20, 2017
Chen L, et al. - This study investigated the association of tricuspid valve regurgitation (TR) presence and severity with patient characteristics, pulmonary artery hemodynamics, and outcome in consecutive patients with newly diagnosed pulmonary arterial hypertension (PAH). In PAH patients, severe TR was identified as a significant predictor of long-term mortality rate and a correlation was observed, between TR severity and PAH severity.
Methods
- This study included consecutive patients with newly diagnosed PAH (N=727 with group 1 pulmonary hypertension) who underwent transthoracic echocardiographic assessment of tricuspid valve function at diagnosis.
- All-cause mortality or lung transplantation was the primary study end point.
Results
- TR was reported in 702 patients (96.5%); in 165 patients (23%), TR was severe.
- Findings demonstrated that, compared with those with no or mild TR by echocardiography criteria, patients with severe TR had shorter mean (SD) 6-minute walk distances (285 [125] m vs 360 [121] m; P=.02) and higher levels of B-type natriuretic peptide (695 [672] pg/dL vs 328 [300] pg/dL;P<.05).
- Researchers observed an association of severe TR with greater right atrial dilatation (91% vs 47%; P=.004) and right ventricular (RV) dilatation (92% vs 51%; P=.008), greater right atrial pressure (mean [SD] 15 [7] mm Hg vs 10 [6] mm Hg;P<.001), and lower cardiac index (mean [SD], 2.2 [0.7] L/min/m2 vs 2.8 [0.9] L/min/m2; P<.001).
- In addition, after adjustment for age, sex, functional class, 6-minute walk distance, diffusing capacity, RV size, and pulmonary vascular resistance index (adjusted hazard ratio, 1.83; 95% CI, 1.38-2.41; P<.001), severe TR strongly predicted greater 5-year mortality risk.
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