Why the study?
Improved risk stratification is needed for decision-making in pulmonary arterial hypertension, which combining right heart catheterization with quantitative CMR tricuspid regurgitation may provide.
Does quantitative tricuspid regurgitation assessment by CMR predict lung transplantation or death in patients with pulmonary arterial hypertension?
Does quantitative tricuspid regurgitation assessment by CMR predict lung transplantation or death in patients with pulmonary arterial hypertension?
Quantitative tricuspid regurgitation by CMR shows a trend toward predicting worse outcomes in PAH and correlates with known prognostic markers, suggesting potential utility in risk stratification.
Aims Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event-free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. Methods and results Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end-diastolic (TRV r = 0.50; TR% r = 0.39) and end-systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r2 = 0.38; r2 = 0.48). Conclusions A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
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Hedström et al. (2020) studied this question.
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