TY - JOUR
T1 - Pulmonary artery pulsatility index in patients with tricuspid valve regurgitation
T2 - a simple non-invasive tool for risk stratification
AU - Kane, Conor J.
AU - Lara-Breitinger, Kyla M.
AU - Alabdaljabar, Mohamad S.
AU - Nkomo, Vuyisile T.
AU - Padang, Ratnasari
AU - Pislaru, Cristina
AU - Kane, Garvan C.
AU - Scott, Christopher
AU - Pislaru, Sorin V.
AU - Lin, Grace
N1 - Publisher Copyright:
© 2023 The Author(s).
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Aims: Tricuspid valve regurgitation (TR) is a common valvular disease associated with increased mortality. There is a need for tools to assess the interaction between the pulmonary artery (PA) circulation and the right ventricle in patients with TR and to investigate their association with outcomes. The pulmonary artery pulsatility index (PAPi) has emerged as a haemodynamic risk predictor in left heart disease and pulmonary hypertension (PH). Whether PAPi discriminates risk in unselected patients with greater than or equal to moderate TR is unknown. Methods and results: In 5079 patients with greater than or equal to moderate TR (regardless of aetiology) and PA systolic and diastolic pressures measured on their first echocardiogram, we compared all-cause mortality at 5 years based on the presence or absence of PH and PAPi levels. A total of 2741 (54%) patients had PH. The median PAPi was 3.0 (IQR 1.9, 4.4). Both the presence of PH and decreasing levels of PAPi were associated with larger right ventricles, worse right ventricular systolic function, higher NT-pro BNP levels, greater degrees of right heart failure, and worse survival. In a subset of patients who had an echo and right heart catheterization within 24 h, the correlation of non-invasive to invasive PA pressures and PAPi levels was very good (r = 0.76). Conclusion: In patients with greater than or equal to moderate TR with and without PH, lower PAPi is associated with right ventricular dysfunction, right heart failure, and worse survival. Incorporating PA pressure and PAPi may help stratify disease severity in patients with greater than or equal to moderate TR regardless of aetiology.
AB - Aims: Tricuspid valve regurgitation (TR) is a common valvular disease associated with increased mortality. There is a need for tools to assess the interaction between the pulmonary artery (PA) circulation and the right ventricle in patients with TR and to investigate their association with outcomes. The pulmonary artery pulsatility index (PAPi) has emerged as a haemodynamic risk predictor in left heart disease and pulmonary hypertension (PH). Whether PAPi discriminates risk in unselected patients with greater than or equal to moderate TR is unknown. Methods and results: In 5079 patients with greater than or equal to moderate TR (regardless of aetiology) and PA systolic and diastolic pressures measured on their first echocardiogram, we compared all-cause mortality at 5 years based on the presence or absence of PH and PAPi levels. A total of 2741 (54%) patients had PH. The median PAPi was 3.0 (IQR 1.9, 4.4). Both the presence of PH and decreasing levels of PAPi were associated with larger right ventricles, worse right ventricular systolic function, higher NT-pro BNP levels, greater degrees of right heart failure, and worse survival. In a subset of patients who had an echo and right heart catheterization within 24 h, the correlation of non-invasive to invasive PA pressures and PAPi levels was very good (r = 0.76). Conclusion: In patients with greater than or equal to moderate TR with and without PH, lower PAPi is associated with right ventricular dysfunction, right heart failure, and worse survival. Incorporating PA pressure and PAPi may help stratify disease severity in patients with greater than or equal to moderate TR regardless of aetiology.
KW - echocardiography
KW - outcomes
KW - pulmonary artery haemodynamics
KW - pulmonary hypertension
KW - right ventricular function
KW - survival
KW - tricuspid valve regurgitation
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U2 - 10.1093/ehjci/jead070
DO - 10.1093/ehjci/jead070
M3 - Article
C2 - 37097062
AN - SCOPUS:85168489990
SN - 2047-2404
VL - 24
SP - 1210
EP - 1221
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 9
ER -