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You are here: Contents > 2012 > Volume 21 Number 6 November 2012 > TRICUSPID VALVE DISEASE > Pulmonary Arterial Pressure and Right Ventricular Dilatation Independently Determine Tricuspid Valve Insufficiency Severity in Pre-Capillary Pulmonary Hypertension

Pulmonary Arterial Pressure and Right Ventricular Dilatation Independently Determine Tricuspid Valve Insufficiency Severity in Pre-Capillary Pulmonary Hypertension

Pieter De Meester, Alexander Van De Bruaene, Marion Delcroix, Ann Belmans, Paul Herijgers, Jens-Uwe Voigt, Werner Budts
Divisions of Cardiology, Pneumology and Cardiac Surgery, University Hospitals Leuven, I-BioStat, KU Leuven, Leuven, Belgium

Background and aim of the study: Elevated pulmonary artery systolic pressure (PASP) causes functional tricuspid valve insufficiency (TI). However, the differential contribution of pressure load and right ventricular (RV) dilatation is not well established. The study aim was to evaluate both variables in relation to TI.
Methods: A cross-sectional study was performed of consecutive transthoracic echocardiographic studies of patients with pre-capillary pulmonary hypertension (PH). Both, demographic data and echocardiographic RV parameters were reviewed. TI was graded semi-quantitatively with color Doppler flow imaging. Trend analyses for TI severity
(TI grade 0/4, 1/4, 2/4, 3/4, or 4/4) were performed. A proportional odds logistic regression analysis was carried out to identify independent predictors of
TI severity.

Results: Eighty-one patients (56 females, 25 males; mean age 60 ± 15 years) with pre-capillary PH were evaluated. Patients with more severe TI had a significantly lower body mass index, a lower mean systemic blood pressure, a shorter pulmonary acceleration time, a higher tricuspid regurgitant gradient, and a more dilated right ventricle. From the echocardiographic parameters, RV dilatation
(p = 0.0143) and the tricuspid regurgitant gradient
(p = 0.0026) were independently related to the degree of TI.
Conclusion: In patients with pre-capillary PH, PASP and RV dilatation were both related to the increasing severity of TI. When focusing on TI to improve the prognosis of patients with pre-capillary PH, both PASP and RV dimensions should be taken into consideration.

The Journal of Heart Valve Disease 2012;21:743-748

Pulmonary Arterial Pressure and Right Ventricular Dilatation Independently Determine Tricuspid Valve Insufficiency Severity in Pre-Capillary Pulmonary Hypertension

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