Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement
Garcia-Ribas, Cora (Universitat Autònoma de Barcelona. Departament de Medicina)
Ble, Mireia (Hospital del Mar (Barcelona, Catalunya))
Gómez, Miquel (Universitat Autònoma de Barcelona. Departament de Medicina)
Mas-Stachurska, Aleksandra (Universitat Autònoma de Barcelona. Departament de Medicina)
Cladellas Capdevila, Mercè (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2021
Resumen:	Background: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2. 8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2. 55 and 2. 8 m/s). Methods: Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5. 8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2. 8 m/s and TRV ≤ 2. 55 m/s), using right atrial area>18 cm 2 and right ventricle/left ventricle ratio>1 as additional echocardiographic variables. Results: In patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2. 55 and 2. 8 m/s TRV thresholds. The intermediate group with TRV > 2. 55 m/s was an independent mortality risk factor (HR 2. 04; 95% CI: 1. 91 to 3. 48, p = 0. 01), in contrast to the intermediate group with TRV>2. 8 m/s (HR 1. 44; 95% CI: 0. 89 to 2. 32, p = 0. 14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1. 62 (95% CI 1. 11 to 2. 35 p = 0. 01) for the new cut-off point; and HR 1. 43 (95% CI: 0. 96 to 2. 13, p = 0. 07) for guidelines threshold. Conclusion: A TRV threshold of 2. 55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Pulmonary hypertension ; Echocardiography ; Tricuspid regurgitation threshold ; Aortic stenosis (AS) ; Left heart valve disease
Publicado en:	Frontiers in Cardiovascular Medicine, Vol. 8 (november 2021) , ISSN 2297-055X

DOI: 10.3389/fcvm.2021.720643
PMID: 34859063

9 p, 1.2 MB

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