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Severe Tricuspid Valve Regurgitation in Patients Diagnosed with Pulmonary Arterial Hypertension

Li-Ju Chen

C. M. Larsen

R Le

Michael McGoon

Robert Frantz

Garvan Kane


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Chen L, Larsen CM, Le RJ, Connolly HM, McGoon MD, Frantz RP, Kane GC

Mayo Clinic, Rochester, MN, USA

BACKGROUND: Tricuspid valve regurgitation (TR) is a frequent finding in patients with pulmonary arterial hypertension (PAH); however the clinical significance of TR in PAH is unclear. The aim of this study was to characterize the relationship of the presence and severity of TR with disease characteristics and outcome in a population of patients newly diagnosed with PAH.

METHODS: 728 consecutive patients with a new diagnosis of Group 1 PH (age 53±15 years) undergoing transthoracic echocardiography and right heart catheterization were studied. The primary outcome was time to all-cause mortality with follow-up censored at time of lung transplant or at five years.

RESULTS: 84% had TR with 160 (22%) having severe TR. Compared to those with none/mild TR, patients with severe TR were more likely to be functional class IV (19% vs 11%, p=0.004), have shorter 6 minute walk distances (285±125 m vs 357±122 m, p<0.0001), and higher BNP levels (figure A). The presence of severe TR was associated with a greater degree of moderate or severe right atrial (93% vs 46%, p<0.0001) and right ventricular (93% vs 51%, <0.0001) dilatation, higher right atrial pressure (15±7 mmHg vs 10±6 mmHg, p<0.0001) and lower cardiac index (2.2±0.7 l/min/m2 vs 2.8±0.9 l/min/m2, p<0.0001). Even after adjusting for the degree of elevation in pulmonary vascular resistance index (PVRI), the presence of severe TR was associated with an additional 10% lower 6 minute walk distance (p<0.001). The presence of severe TR at diagnosis was associated with a greater mortality on follow-up (p<0.0001; figure B). Severe TR was associated with mortality independent of age, sex, functional class, right ventricular enlargement and PVRI (adjusted HR 1.75, 95% C.I. 1.31-2.32, p<0.001).

 Severe Tricuspid Valve Regurgitation in Patients Diagnosed with Pulmonary Arterial Hypertension

CONCLUSIONS: Severe tricuspid regurgitation is a significant predictor of long-term mortality in patients with PAH and the risk is in part independent of the degree of right ventricular dilation and pulmonary artery hemodynamics.