Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement
Background: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:627a6f4ed96444ca8b693be7f0d70eca2021-11-10T08:00:27ZImportance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement2297-055X10.3389/fcvm.2021.720643https://doaj.org/article/627a6f4ed96444ca8b693be7f0d70eca2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.720643/fullhttps://doaj.org/toc/2297-055XBackground: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s).Methods: Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm2 and right ventricle/left ventricle ratio>1 as additional echocardiographic variables.Results: In patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, p = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, p = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 p = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, p = 0.07) for guidelines threshold.Conclusion: A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.Cora Garcia-RibasCora Garcia-RibasMirea BleMiquel GómezMiquel GómezMiquel GómezAleksandra Mas-StachurskaNúria Farré-LópezNúria Farré-LópezNúria Farré-LópezMercè CladellasMercè CladellasMercè CladellasFrontiers Media S.A.articlepulmonary hypertensionechocardiographytricuspid regurgitation thresholdaortic stenosis (AS)left heart valve diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
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pulmonary hypertension echocardiography tricuspid regurgitation threshold aortic stenosis (AS) left heart valve disease Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
pulmonary hypertension echocardiography tricuspid regurgitation threshold aortic stenosis (AS) left heart valve disease Diseases of the circulatory (Cardiovascular) system RC666-701 Cora Garcia-Ribas Cora Garcia-Ribas Mirea Ble Miquel Gómez Miquel Gómez Miquel Gómez Aleksandra Mas-Stachurska Núria Farré-López Núria Farré-López Núria Farré-López Mercè Cladellas Mercè Cladellas Mercè Cladellas Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| description |
Background: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s).Methods: Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm2 and right ventricle/left ventricle ratio>1 as additional echocardiographic variables.Results: In patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, p = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, p = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 p = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, p = 0.07) for guidelines threshold.Conclusion: A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation. |
| format |
article |
| author |
Cora Garcia-Ribas Cora Garcia-Ribas Mirea Ble Miquel Gómez Miquel Gómez Miquel Gómez Aleksandra Mas-Stachurska Núria Farré-López Núria Farré-López Núria Farré-López Mercè Cladellas Mercè Cladellas Mercè Cladellas |
| author_facet |
Cora Garcia-Ribas Cora Garcia-Ribas Mirea Ble Miquel Gómez Miquel Gómez Miquel Gómez Aleksandra Mas-Stachurska Núria Farré-López Núria Farré-López Núria Farré-López Mercè Cladellas Mercè Cladellas Mercè Cladellas |
| author_sort |
Cora Garcia-Ribas |
| title |
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| title_short |
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| title_full |
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| title_fullStr |
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| title_full_unstemmed |
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement |
| title_sort |
importance of tricuspid regurgitation velocity threshold in risk assessment of pulmonary hypertension-long-term outcome of patients submitted to aortic valve replacement |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/627a6f4ed96444ca8b693be7f0d70eca |
| work_keys_str_mv |
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