Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation

Gual-Capllonch, Francisco; Teis, Albert; Ferrer, Elena; Núñez, Julio; Vallejo, Nuria Garatachea; Juncà, Gladys; López-Ayerbe, Jorge; Lupón, Josep; Bayés‐Genís, Antoni

doi:10.1111/echo.14125

Cited by 7 publications

(2 citation statements)

References 27 publications

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“…They were thorough explorations with special attention paid to the right heart chambers and pulmonary haemodynamics, with the aim of providing insights into right heart afterload adaptation. The study protocol was designed to recruit cases with complete data, no right heart abnormalities due to primary causes and avoiding cases with normal RV, strictly normal pulmonary artery systolic pressure (PASP), and absent or physiological tricuspid regurgitation [13]. Therefore, inclusion criteria were the presence of FTR with at least one of the following conditions: PASP 35 mmHg, or any degree of RV dilatation or RV dysfunction.…”

Section: Study Design and Populationmentioning

confidence: 99%

Sex-Related Differences in the Mechanism of Functional Tricuspid Regurgitation

Gual-Capllonch

Cediel

Ferrer

et al. 2021

Heart, Lung and Circulation

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Predictive factors of significant functional tricuspid regurgitation (FTR) are not completely understood. We investigated sex-related differences in predictors of FTR progression. Method Clinical and echocardiographic variables were recorded in a prospective single-centre observational cohort of 251 consecutive stable patients with FTR. Multivariable logistic regression analyses stratified by sex were performed to identify predictors of significant FTR. Results The mean age of the whole cohort was 72.2611.4 years, and 133 (53%) patients were women. Females tended to have a higher prevalence of significant FTR (22.6% vs 13.6%; p=0.066). Women were also older than men (mean age 74.4 vs 69.6 years; p,0.001), with more frequent history of arterial hypertension, worse New York Heart Association functional class, higher E/e' quotient, and higher left ventricular ejection fraction. The independent predictors of significant FTR in women were atrial fibrillation (AF) (odds ratio [OR] 10.8, 95% confidence interval [CI] 2.9-40.7; p,0.001), indexed tricuspid diameter annulus (OR 1.24, 95% CI 1.04-1.47; p=0.017), and pulmonary artery systolic pressure (PASP) (OR 1.09, 95% CI 1.04-1.15; p=0.001). The independent predictors of outcome in men were indexed tricuspid tenting height (OR 2.71, 95% CI 1.20-6.11; p=0.016), indexed tricuspid diameter annulus (OR 1.98, 95% CI 1.26-3.09; p=0.003), and PASP (OR 1.08, 95% CI 1.01-1.16; p=0.021). Conclusions The presence of AF and longer indexed tenting height convey a greater risk of significant FTR in females and males, respectively. These findings suggest the existence of different physiopathological mechanisms involved in the progression of FTR in both sexes.

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Section: Study Design and Populationmentioning

confidence: 99%

Sex-Related Differences in the Mechanism of Functional Tricuspid Regurgitation

Gual-Capllonch

Cediel

Ferrer

et al. 2021

Heart, Lung and Circulation

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“…PVR measurements are established in the context of pulmonary hypertension [15], and studies have shown that high PVR is associated with unfavorable right ventricular remodeling and outcome in patients with tricuspid valve regurgitation [16,17]. As a marker of right heart function and congestion [18], PVR has been used as an endpoint in numerous clinical trials [19,20].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Vascular Resistance to Predict Right Heart Failure in Patients Undergoing Left Ventricular Assist Device Implantation

Schramm,

Kirchner,

Ibrahim

et al. 2024

JCM

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Right heart failure (RHF) is associated with poor outcomes, especially in patients undergoing left ventricular assist device (LVAD) implantation. The aim of this study was to identify predictors of RHF after LVAD implantation. Of 129 consecutive patients (mean age 56 ± 11 years, 89% male) undergoing LVAD implantation, 34 developed RHF. Compared to patients without RHF, those with RHF required longer invasive mechanical ventilation and had longer intensive care unit and hospital stays (p < 0.01). One-year all-cause mortality was significantly higher in patients with versus without RHF after LVAD implantation (29.4% vs. 1.2%; hazard ratio 35.4; 95% confidence interval 4.5–277; p < 0.001). Mortality was highest in patients with delayed RHF after initial LVAD-only implantation (66.7%). Patients who did versus did not develop RHF had significantly higher baseline pulmonary vascular resistance (PVR; 404 ± 375 vs. 234 ± 162 dyn/s/cm5; p = 0.01). PVR > 250 dyn/s/cm5 was a significant predictor of survival in patients with RHF after LVAD implantation. These data confirm the negative impact of RHF on morbidity and mortality after LVAD implantation. Preoperative PVR > 250 dyn/s/cm5 determined using invasive right heart catheterization was an independent predictor of developing RHF after LVAD implantation, and of subsequent mortality, and could be used for risk stratification in the setting for deciding between single or biventricular support strategy.

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