Abstract 13239: The Relation of Tricuspid Regurgitation to the Right and Left Ventricular Three-Dimensional Geometry and Hemodynamics in Patients With Chronic Pulmonary Hypertension
Background: The aim was to assess the relation of tricuspid regurgitation (TR) severity to biventricular volumes and ejection dynamics using 3-dimensional (3D) echocardiography in patients with chronic pulmonary arterial hypertension (PAH).
Methods: We studied 43 chronic PAH patients using 3D echocardiography (Toshiba Corp.). TR was graded from 0 to 3 (0=none, 1=mild, 2= moderate, 3=severe). Routine measurements included tricuspid annular plane systolic excursion (TAPSE), peak tricuspid regurgitation jet gradient (Vpeak), left ventricular (LV) and right ventricular (RV) myocardial performance index (MPILV, MPIRV) and Doppler stroke volume (LVSVIDoppler). RV and LV ejection fraction (EFLV, EFRV), end-diastolic volumes (EDVILV, EDVIRV), end-systolic volumes (ESVILV, ESVIRV) and stroke volumes (LVSVIvol, RVSVIvol) were measures by 3D echocardiography.
Results: Patients with every grade of TR (mild to severe) had significantly higher Vpeak (3.0m/s vs. 3.6m/s, 4.0m/s and 3.8m/s, all p<0.01) compared to no TR patients. Severe TR patients had significantly lower TAPSE (19.0mm vs. 14.9mm, p<0.01) and LVSVIDoppler (32.3ml/m2 vs. 23.1ml/m2, p<0.05). 3D RV dilatation was related to significant TR (moderate and severe), EDVIRV (38.9 ml/m2 vs. 70.2 ml/m2, 99.4 ml/m2, both p<0.01), ESVIRV (24.2 ml/m2 vs. 49.2 ml/m2, 72.7 ml/m2, both p<0.01) and RVSVIvol (14.7ml/m2 vs. 20.9ml/m2, p<0.05 and 26.7 ml/m2, p<0.01). Severe TR patients had significantly lower EFLV (44% vs. 53%, p<0.01) and LVSVIvol (15.4ml/m2 vs.26.3ml/m2, p<0.05). ESVIRV positively correlated with RVSVIvol (r=0.56, p<0.01) and negatively with LVSVIDoppler (r=-0.40, p<0.05).
Conclusion: TR severely related to 3D RV remodeling, RV ejection dynamics and also LV function. 3D echocardiography is useful to assess biventricular alterations in patients with chronic PAH.
- © 2013 by American Heart Association, Inc.