Abstract 14037: The Additive Effects of Tricuspid Regurgitation and Pressure Overload in Pulmonary Hypertension on Three-Dimensional Right Ventricular Mechanics and Patient Outcomes
Introduction: Pulmonary hypertension (PH) results in chronic right ventricular (RV) pressure overload and variable degrees of tricuspid regurgitation (TR). The combined effects of RV pressure and volume overload on PH patient outcomes are unclear.
Methods: We studied 93 PH patients with invasive hemodynamics and 3D echo imaging (Toshiba Corp.) measuring RV end-diastolic and end-systolic volume index (EDVI, ESVI), and RV ejection fraction (EF). TR was graded (0=none, 1=mild, 2=moderate, 3=severe), PH patients were divided in 4 groups based on the mean pulmonary artery pressure (mPAP) and TR severity (≤ moderate was defined as significant TR+). Outcome analysis over 6 months was the combined end-point of first PH hospitalization, all-cause mortality, lung transplantation or pulmonary endarterectomy.
Results: Of the 93 PH patients, there were 40 (43%) with significant TR+. 3D RV EDVI was larger in patients with significant TR+ than others (129 ml/m2* vs. 93 ml/m2, *p<0.001). RV EF was 30±9%* in patients with significant TR+ vs. 36±9% in those without significant TR (p=0.003). In patients with significant TR+, 19 (48%) had mPAP ≤ 45mmHg and 21 (52%) had mPAP < 45mmHg. Kaplan-Mayer analysis showed that the subgroup of patients with both significant TR+ and mPAP ≤ 45mmHg had the worst prognosis, and TR+ was additive to high mPAP (Log rank p < 0.01).
Conclusion: 3D echocardiographic RV analysis of PH patients with invasive hemodynamics demonstrated that there are additive effects of pressure overload and volume overload by TR on RV mechanics which were strongly related to the outcomes, and of clinical importance.
Author Disclosures: K. Ryo: None. A. Goda: None. A. Delgado-Montero: None. B. Tayal: None. M.A. Simon: None. M.A. Mathier: Research Grant; Modest; Actelion, United Therapeutics, Gilead. J. Gorcsan: Research Grant; Modest; Biotoronik, GE, Toshiba, Medtronic, St.Jude Medical.
- © 2014 by American Heart Association, Inc.