Moderate or severe secondary tricuspid regurgitation was independently associated with all-cause mortality (454 deaths among 1,318 patients) in pulmonary hypertension over a median 1.5 years.
Cohort (n=1,318)
Does moderate or severe secondary tricuspid regurgitation increase all-cause mortality in patients with pulmonary hypertension?
Moderate or severe secondary tricuspid regurgitation is an independent predictor of mortality in patients with pulmonary hypertension, beyond the risk conferred by right ventricular dysfunction.
BACKGROUND: Secondary tricuspid regurgitation (STR) is frequently observed in patients with pulmonary hypertension (PH). Whether it independently confers mortality risk beyond the associated right ventricular (RV) dysfunction remains unknown. OBJECTIVES: The aim of this study was to evaluate the prognostic significance of STR in patients with PH other than related to left-sided valve disease or reduced ejection fraction and across the individual World Health Organization (WHO) groups of PH. METHODS: Patients with RV systolic pressures ≥50 mm Hg on echocardiography between 2010 and 2023 and measured RV free wall longitudinal strain were identified retrospectively. Primary tricuspid valve disease, reduced left ventricular ejection fraction, significant left-sided valve disease, congenital heart disease, decompensated cirrhosis, malignancy, and dialysis were exclusion criteria. PH was classified according to the WHO group classification. Patients were followed for all-cause mortality. RESULTS: Of 1,318 patients (mean age 67 years, 61% women, 29% with moderate or greater STR, median RV free wall longitudinal strain 19%), WHO groups 1, 2, 3, and 4 PH were present in 33%, 11%, 32%, and 12%, respectively. Patients with moderate or greater STR were more symptomatic and congested and had worse RV function and pulmonary pressures. Over a median 1.5 years (Q1-Q3: 0.3-4.6 years), 454 patients died. Moderate or severe STR was associated with mortality independent of various RV function measures or RV-pulmonary arterial coupling. This remained true across the individual WHO groups of PH. CONCLUSIONS: Moderate or severe STR conferred mortality risk in patients with PH without left-sided valve disease or reduced left ventricular ejection fraction, beyond what can be explained by the associated RV dysfunction or impaired RV-pulmonary arterial coupling. Whether STR may represent an additional therapeutic target in certain subgroups with PH requires future investigation.
Naser et al. (Mon,) conducted a cohort in Pulmonary hypertension (n=1,318). Moderate or severe secondary tricuspid regurgitation vs. Less than moderate secondary tricuspid regurgitation was evaluated on All-cause mortality. Moderate or severe secondary tricuspid regurgitation was independently associated with all-cause mortality (454 deaths among 1,318 patients) in pulmonary hypertension over a median 1.5 years.
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