Severity of functional tricuspid regurgitation is associated with mortality in patients with pulmonary hypertension in long‐term follow‐up

Abstract

Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic state present in many cardiovascular, respiratory, and systemic diseases. PH is considered to have a higher risk of cardiovascular events and mortality. The most common type of functional tricuspid regurgitation (FTR) is associated with PH. The aim of this study was to evaluate the association between FTR severity and mortality in PH in western China. This is a retrospective analysis in PH patients and all patients underwent right‐heart catheterization (RHC) for hemodynamic measurements. The FTR severity was determined according to the guidelines. Uni‐ and multivariate analyses were used to identify risk factors for mortality. From 2015 to 2021, 136 patients with PH with a median age of 50 years (interquartile range [IQR]: 35–64 years). During 26‐month median follow‐up (mean 27.7 ± 15.1 months), 40 (29.2%) patients died (mean after 21.7 ± 14.1 months). In the univariate Cox regression analysis, World Health Organization functional class (WHO FC) III/IV, elevated B‐type natriuretic peptide, pulmonary vascular resistance (≥16.2 Wood units), pulmonary artery oxygen saturation, severe FTR and right ventricular diameter/left ventricular diameter (≥0.62) were significantly associated with mortality. In the multivariate Cox regression analysis, severe FTR, WHO FC III/IV, and right ventricular end‐diastolic pressure (RVEDP) were risk factors for mortality. Severe FTR at baseline was strongly associated with mortality in both precapillary and postcapillary PH patients, independent of the other risk factors as RVEDP, HO FC III/IV, optimal pulmonary arterial hypertension targeted therapy.

Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension

“…Functional tricuspid regurgitation is characterized by an anatomically normal tricuspid valve (TV) structure. 6 - 8 The mechanism of FTR begins when the right ventricle (RV) afterload increases owing to PAH and eventually leads to RV remodeling, TR, and RV failure. 8 - 10 Several factors, such as pregnancy and smoking, worsen the outcomes of PAH.…”