Moderate-to-severe tricuspid regurgitation was associated with increased cardiovascular mortality compared to none/mild TR in Group 3 pulmonary hypertension (log-rank p=0.003), but not in Group 1 PAH.
Cohort (n=490)
No
Does moderate or severe tricuspid regurgitation predict cardiovascular death differently in patients with Group 3 pulmonary hypertension compared to Group 1 pulmonary arterial hypertension?
Moderate to severe tricuspid regurgitation is a significant predictor of cardiovascular death in Group 3 pulmonary hypertension, but not in Group 1 PAH, suggesting it is a marker of heightened right ventricular compromise.
p-value: p=0.003
Abstract Rationale Patients with Group 3 pulmonary hypertension (PH) have the lowest survival rates among all PH etiologies. Right ventricular dysfunction (RVD) drives poor outcomes in Group 3 PH, but an evaluation of tricuspid regurgitation (TR) in Group 3 PH is lacking. We investigated the clinical and prognostic significance of TR in patients with Group 3 PH compared to patients with Group 1 pulmonary arterial hypertension (PAH). Methods We performed a retrospective, single-center registry study of consecutive patients with Group 1 PAH (n = 250) and Group 3 PH (n = 240) at the University of Minnesota. Baseline demographics, medications, echocardiogram data, right heart catheterization (RHC) measures, and common labs were collected within six months of registry enrollment. TR severity was obtained from echocardiograms and categorized as none/mild, moderate, or severe. Kruskal-Wallis tests analyzed associations between TR severity and echocardiographic measures, invasive hemodynamics, and clinical biomarkers. Kaplan-Meier survival analyses were performed for group 1 and group 3 PH for cardiovascular death. Results Moderate or severe TR was more prevalent in Group 1 PAH compared to Group 3 PH, 46% vs 32%, respectively. However, PVR was lower in Group 3 PH than PAH in both the moderate and severe TR groups. Increasing TR severity was more strongly associated with RV dysfunction and more severe pulmonary vascular disease in PAH patients (Table 1). In contrast, TR severity showed greater association with renal dysfunction in group 3 PH (Table 1). Kaplan-Meier analysis demonstrated increased cardiovascular mortality among group 3 PH patients with moderate-severe TR compared with none/mild TR (log-rank p = 0.003), but it was not associated with cardiovascular death in group 1 PAH (log rank p = 0.07). Conclusion Group 3 patients develop significant TR with less afterload than PAH patients, suggesting they have more RV compromise. Worsening TR is more strongly associated with renal dysfunction, and is more predictive of cardiovascular death in Group 3 PH. TR appears to be another sign of heightened RV compromise in Group 3 PH. This abstract is funded by: None
Clark et al. (Fri,) conducted a cohort in Group 1 and Group 3 Pulmonary Hypertension (n=490). Moderate or severe tricuspid regurgitation vs. None or mild tricuspid regurgitation was evaluated on Cardiovascular death (p=0.003). Moderate-to-severe tricuspid regurgitation was associated with increased cardiovascular mortality compared to none/mild TR in Group 3 pulmonary hypertension (log-rank p=0.003), but not in Group 1 PAH.
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