Key result
RVD/LVD ratio linked to ~473% greater odds of high-risk status in precapillary PH.
Why the study?
The incidence of different tricuspid regurgitation degrees and the impact of TR severity on pulmonary artery pressure assessment and clinical risk stratification in precapillary pulmonary hypertension are poorly defined.
Observational (n=207)
No
Odds Ratio: 5.734 (95% CI 1.502–21.889)
p-value: p=0.011
In precapillary pulmonary hypertension, significant tricuspid regurgitation is not always present, and echocardiographic estimation of pulmonary artery pressure is unreliable in patients with trace or no TR.
Echocardiographic sPAP estimation unreliable in trace TR; hypothesis-generating for RVD/LVD, RA area, and S' as high-risk precapillary PH predictors.
Background In precapillary pulmonary hypertension (PH), the incidence of different tricuspid regurgitation (TR) degree is poorly defined. The impact of TR severity on pulmonary artery pressure (PAP) assessment and clinical risk stratification in precapillary PH remains unclear. Methods A total of 207 patients diagnosed precapillary PH who underwent right heart catheterization (RHC) and echocardiography within 3 days were included. The severity of TR was graded as trace, mild, moderate and severe. Pearson correlation analysis was performed to evaluate the correlation between systolic PAP by echocardiography (sPAPECHO) and mean PAP by RHC (mPAPRHC) in different TR degree groups. The impact factors on risk stratification of precapillary PH were analyzed by logistic regression analysis. Results The proportion of None, Trace, Mild, Moderate and Severe TR group was 2.4%, 23.7%, 39.1%, 28.5% and 6.3% respectively. Right atrium (RA) area increased gradually with TR aggravation (p < 0.001). Moderate and Severe TR group had higher N-terminal pro-B-type natriuretic peptide (p < 0.001), right atrial pressure (RAP) (p = 0.018), right ventricular basal diameter (RVD)/left ventricular basal diameter (LVD) ratio (p < 0.001), larger right ventricle (RV) (p < 0.001) and lower tricuspid annular plane systolic excursion (p = 0.006) compared with Trace and Mild group. TR-sPAPECHO in Moderate TR group had the greatest correlation coefficient with mPAPRHC (0.742, p < 0.001) followed by Mild (0.635, p < 0.001) and severe group (0.592, p = 0.033), while there was no correlation in Trace TR group (0.308, p = 0.076). Multivariate logistic regression showed three significant independent echocardiography predictors of high-risk precapillary PH: RVD/LVD ratio (OR = 5.734; 95%CI1.502–21.889, p = 0.011), RA area (OR 1.054; 95% CI 1.004–1.107, p = 0.035) and systolic annular tissue velocity of the lateral tricuspid annulus (S’) (OR 0.735, 95% CI 0.569–0.949, p = 0.018). Conclusions Precapillary PH was not necessarily accompanied by significant TR. None or Trace TRaccounted for 26% in our population and TR-sPAPECHO was not applicable to estimate PAP in these patients. RVD/LVD ratio, RA area and S’ can independently predict the high-risk patients with precapillary PH. TR may play an indirect role in risk stratification by affecting these indicators.
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Li et al. (2022) conducted an observational in Precapillary pulmonary hypertension (n=207). Tricuspid regurgitation and related echocardiographic parameters was evaluated on High-risk precapillary pulmonary hypertension (predicted by RVD/LVD ratio) (OR 5.734, 95% CI 1.502-21.889, p=0.011). In patients with precapillary pulmonary hypertension, the RVD/LVD ratio independently predicted high-risk status (OR 5.734), while tricuspid regurgitation severity played an indirect role.
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