Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for…

AIMS:

Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR.

A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) 50mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death,heart failurehospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175-402) days. iPHT+ patients were at higher preoperative risk (P<0.01), had more severe symptoms (P=0.01), higher N-terminal pro-B-type natriuretic peptide levels (P<0.01), more impaired right ventricular (RV) function (P<0.01), and afterload corrected RV function (P<0.01). Procedural TTVR success was similar in iPHT+ and iPHT- patients (84 vs. 84%, P=0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT- carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25-6.37), P<0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT- patients (P=0.48). In patients with isolated tricuspid procedure (n=131) a discordant iPHT+/ePHT- diagnosis and an impaired afterload corrected RV function (P<0.01 for both) were independent predictors for the occurrence of the combined endpoint.

The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR.

Visit link:
Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for...