title: Pulmonary arterial pressure and right ventricular dilatation independently determine tricuspid valve insufficiency severity in pre-capillary pulmonary hypertension.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Cardiology, University Hospitals Leuven, 3I-BioStat, KU Leuven, Leuven, Belgium.
authors: Pieter
authors: P
authors: De Meester
authors: Alexander
authors: A
authors: Van De Bruaene
authors: Marion
authors: M
authors: Delcroix
authors: Ann
authors: A
authors: Belmans
authors: Paul
authors: P
authors: Herijgers
authors: Jens-Uwe
authors: JU
authors: Voigt
authors: Werner
authors: W
authors: Budts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013599:Systole; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology