title: Tricuspid regurgitation progression and regression in pulmonary arterial hypertension: implications for right ventricular and tricuspid valve apparatus geometry and patients outcome.
abstract: OBJECTIVE
  The aim of this study was to determine the mechanism of tricuspid regurgitation (TR) progression in pulmonary arterial hypertension (PAH) and its effect on survival.
  
  
  RESULTS
  We studied 88 patients with PAH and functional TR (mean pulmonary artery pressure 49 ± 14 mmHg; 43% idiopathic PAH) who had serial echocardiograms. TR progression (n = 35) was defined as ≤mild TR on Echo 1 and ≥moderate TR on Echo 2. TR regression (n = 17) was defined as ≥moderate TR on Echo 1 and ≤mild TR on Echo 2. Stable TR (n = 36) was defined as ≤mild TR on both echoes. TR progression was associated with an increase in pulmonary artery systolic pressure (PASP, 62 ± 22-92 ± 23 mmHg, P < 0.0001), right ventricular (RV) enlargement, mainly at mid-ventricular level, increased RV sphericity (6.1 ± 1.7-6.9 ± 1.8, P = 0.004), tricuspid annular (TA) dilatation (4.0 ± 0.7-4.6 ± 0.7 cm, P < 0.0001), and increased tricuspid valve (TV) tenting area (2.0 ± 0.7-2.5 ± 1.0 cm2, P = 0.0003). TR regression was associated with a reduction in PASP (84 ± 15-55 ± 18 mmHg, P < 0.0001), reverse RV remodelling with a reduction in RV sphericity (6.3 ± 1.4-5.5 ± 1.0, P = 0.02), and a reduction in TA size (4.1 ± 0.7-3.6 ± 0.7 cm, P = 0.02) and TV tenting (2.1 ± 0.7-1.3 ± 0.5 cm2, P = 0.0002). TR progression was associated with all-cause mortality (log-rank P = 0.0007).
  
  
  CONCLUSIONS
  In PAH, TR progression was associated with worsening pulmonary hypertension and adverse RV and TV apparatus remodelling. TR progression is associated with poor outcome in PAH.
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Medvedofsky
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.|The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Thomeas
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Rich
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Kirk
authors.initials: K
authors.lastname: Spencer
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel av.shiran@gmail.com.|Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel.
authors.forename: Avinoam
authors.initials: A
authors.lastname: Shiran
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D016019:Survival Analysis; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: progression; pulmonary arterial hypertension; regression; remodelling; tricuspid regurgitation