title: Tricuspid regurgitation duration correlates with cardiovascular magnetic resonance-derived right ventricular ejection fraction and predict prognosis in patients with pulmonary arterial hypertension.
abstract: OBJECTIVE
  Right ventricular (RV) failure is known to be the main cause of mortality and is closely related to prognosis in patients with pulmonary arterial hypertension (PAH). A decrease in the duration of tricuspid regurgitation corrected for heart rate (TRDc) has recently been shown to be associated with advanced RV failure and poor clinical outcomes. The aim of the present study was to investigate whether TRDc correlates with RV parameters assessed using cardiovascular magnetic resonance (CMR) and has prognostic significance in patients with PAH.
  
  
  RESULTS
  Thirty-seven consecutive patients with PAH (28 females, age 46 ± 14 years) underwent a 6 min walk test, right heart catheterization, echocardiography, and CMR within a 48 h period. Tricuspid regurgitation duration corrected for heart rate, tricuspid annular plane systolic excursion (TAPSE), Tei index, and tricuspid valve lateral annular systolic velocity were measured on echocardiography, and RV end-systolic and end-diastolic volumes and ejection fraction were measured on CMR. Tricuspid regurgitation duration corrected for heart rate was positively correlated with RV ejection fraction as measured on CMR (r = 0.400, P = 0.014). On multivariate regression analysis, TRDc was also significantly correlated with RV ejection fraction even after adjusting for the eccentric index, Tei index, and TAPSE (P = 0.034). During a median follow-up period of 487 days, there were seven events (19%) including two cardiac deaths and five inpatient admissions for heart failure. The event-free survival rate was significantly higher for patients with TRDc >400 ms than those with TRDc ≤400 ms (P = 0.040).
  
  
  CONCLUSIONS
  Tricuspid regurgitation duration corrected for heart rate correlated with CMR-derived RV ejection fraction, and decreased TRDc was associated with cardiovascular mortality and rehospitalization in patients with PAH. Therefore, TRDc could be a useful echocardiographic surrogate marker for predicting RV dysfunction and prognosis in patients with PAH.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: In-Jeong
authors.initials: IJ
authors.lastname: Cho
authors.forename: Jaewon
authors.initials: J
authors.lastname: Oh
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.forename: Ki-Woon
authors.initials: KW
authors.lastname: Kang
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Byoung-Wook
authors.initials: BW
authors.lastname: Choi
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Shin
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
mesh_terms: D055424:Cardiac-Gated Imaging Techniques; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D013599:Systole; D014261:Tricuspid Valve / Q000503:physiopathology*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis* / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Prognosis; Pulmonary arterial hypertension; Right ventricular function