Severity of functional tricuspid regurgitation is associated with mortality in patients with pulmonary hypertension in long‐term follow‐up

Abstract Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic state present in many cardiovascular, respiratory, and systemic diseases. PH is considered to have a higher risk of cardiovascular events and mortality. The most common type of functional tricuspid regurgitation (FTR) is associated with PH. The aim of this study was to evaluate the association between FTR severity and mortality in PH in western China. This is a retrospective analysis in PH patients and all patients underwent right‐heart catheterization (RHC) for hemodynamic measurements. The FTR severity was determined according to the guidelines. Uni‐ and multivariate analyses were used to identify risk factors for mortality. From 2015 to 2021, 136 patients with PH with a median age of 50 years (interquartile range [IQR]: 35–64 years). During 26‐month median follow‐up (mean 27.7 ± 15.1 months), 40 (29.2%) patients died (mean after 21.7 ± 14.1 months). In the univariate Cox regression analysis, World Health Organization functional class (WHO FC) III/IV, elevated B‐type natriuretic peptide, pulmonary vascular resistance (≥16.2 Wood units), pulmonary artery oxygen saturation, severe FTR and right ventricular diameter/left ventricular diameter (≥0.62) were significantly associated with mortality. In the multivariate Cox regression analysis, severe FTR, WHO FC III/IV, and right ventricular end‐diastolic pressure (RVEDP) were risk factors for mortality. Severe FTR at baseline was strongly associated with mortality in both precapillary and postcapillary PH patients, independent of the other risk factors as RVEDP, HO FC III/IV, optimal pulmonary arterial hypertension targeted therapy

Table_1_Non-invasive global myocardial work index as a new surrogate of ventricular-arterial coupling in hypertensive patients with preserved left ventricular ejection fraction.docx

ObjectiveAs a new method of left ventricular-arterial coupling (VAC), the non-invasive myocardial work index (MWI) may provide more useful information than the classical methods of arterial elastance/left ventricular (LV) elastance index (the ratio of effective arterial elastance (Ea) over end-systolic elastance [Ea/Ees]). This research aims to investigate if MWI might be better associated with hypertension-mediated organ damage (HMOD) and diastolic dysfunction than Ea/Ees in hypertension.MethodsWe prospectively enrolled 104 hypertensives and 69 normotensives. All subjects had speckle-tracking echocardiography for myocardial work, conventional echocardiography, and brachial-ankle pulse wave velocity (baPWV) measurements. The global work index (GWI) is a myocardial work component. The correlation between GWI and HMOD, as well as diastolic dysfunction, was analyzed. The receiver operating characteristic (ROC) curve was utilized for evaluating the GWI predicting efficacy.ResultsThe global work index was significantly higher in hypertensives than in normotensives (2,021.69 ± 348.02 vs. 1,757.45 ± 225.86 mmHg%, respectively, p ConclusionsThe global work index but not traditionally echocardiographic-derived Ea/Ees of VAC is independently related to HMOD and diastolic impairment in hypertensives with preserved LV ejection fraction. The GWI may be a potential marker for evaluating the VAC in hypertension.</p