Tricuspid Regurgitation Progression and Regression in Pulmonary Arterial Hypertension: Implications for Right Ventricular and Tricuspid Valve Apparatus Geometry and Patients Outcome

Eur Heart J Cardiovasc Imaging. 2017 Jan;18(1):86-94. doi: 10.1093/ehjci/jew010. Epub 2016 Feb 11.

Abstract

Aims: The aim of this study was to determine the mechanism of tricuspid regurgitation (TR) progression in pulmonary arterial hypertension (PAH) and its effect on survival.

Methods and results: We studied 88 patients with PAH and functional TR (mean pulmonary artery pressure 49 ± 14 mmHg; 43% idiopathic PAH) who had serial echocardiograms. TR progression (n = 35) was defined as ≤mild TR on Echo 1 and ≥moderate TR on Echo 2. TR regression (n = 17) was defined as ≥moderate TR on Echo 1 and ≤mild TR on Echo 2. Stable TR (n = 36) was defined as ≤mild TR on both echoes. TR progression was associated with an increase in pulmonary artery systolic pressure (PASP, 62 ± 22-92 ± 23 mmHg, P < 0.0001), right ventricular (RV) enlargement, mainly at mid-ventricular level, increased RV sphericity (6.1 ± 1.7-6.9 ± 1.8, P = 0.004), tricuspid annular (TA) dilatation (4.0 ± 0.7-4.6 ± 0.7 cm, P < 0.0001), and increased tricuspid valve (TV) tenting area (2.0 ± 0.7-2.5 ± 1.0 cm2, P = 0.0003). TR regression was associated with a reduction in PASP (84 ± 15-55 ± 18 mmHg, P < 0.0001), reverse RV remodelling with a reduction in RV sphericity (6.3 ± 1.4-5.5 ± 1.0, P = 0.02), and a reduction in TA size (4.1 ± 0.7-3.6 ± 0.7 cm, P = 0.02) and TV tenting (2.1 ± 0.7-1.3 ± 0.5 cm2, P = 0.0002). TR progression was associated with all-cause mortality (log-rank P = 0.0007).

Conclusion: In PAH, TR progression was associated with worsening pulmonary hypertension and adverse RV and TV apparatus remodelling. TR progression is associated with poor outcome in PAH.

Keywords: progression; pulmonary arterial hypertension; regression; remodelling; tricuspid regurgitation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Cause of Death
  • Cohort Studies
  • Comorbidity
  • Disease Progression
  • Echocardiography / methods*
  • Echocardiography, Doppler, Color / methods
  • Female
  • Humans
  • Hypertension, Pulmonary / diagnostic imaging*
  • Hypertension, Pulmonary / epidemiology*
  • Hypertension, Pulmonary / physiopathology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Severity of Illness Index
  • Survival Analysis
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / physiopathology
  • Tricuspid Valve Insufficiency / diagnostic imaging*
  • Tricuspid Valve Insufficiency / epidemiology*
  • Tricuspid Valve Insufficiency / physiopathology
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / mortality
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Remodeling / physiology*