Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Rd, Chaoyang, Beijing, 100029, China.
Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
BMC Pulm Med. 2022 Nov 9;22(1):409. doi: 10.1186/s12890-022-02207-4.
In precapillary pulmonary hypertension (PH), the incidence of different tricuspid regurgitation (TR) degree is poorly defined. The impact of TR severity on pulmonary artery pressure (PAP) assessment and clinical risk stratification in precapillary PH remains unclear.
A total of 207 patients diagnosed precapillary PH who underwent right heart catheterization (RHC) and echocardiography within 3 days were included. The severity of TR was graded as trace, mild, moderate and severe. Pearson correlation analysis was performed to evaluate the correlation between systolic PAP by echocardiography (sPAP) and mean PAP by RHC (mPAP) in different TR degree groups. The impact factors on risk stratification of precapillary PH were analyzed by logistic regression analysis.
The proportion of None, Trace, Mild, Moderate and Severe TR group was 2.4%, 23.7%, 39.1%, 28.5% and 6.3% respectively. Right atrium (RA) area increased gradually with TR aggravation (p < 0.001). Moderate and Severe TR group had higher N-terminal pro-B-type natriuretic peptide (p < 0.001), right atrial pressure (RAP) (p = 0.018), right ventricular basal diameter (RVD)/left ventricular basal diameter (LVD) ratio (p < 0.001), larger right ventricle (RV) (p < 0.001) and lower tricuspid annular plane systolic excursion (p = 0.006) compared with Trace and Mild group. TR-sPAP in Moderate TR group had the greatest correlation coefficient with mPAP (0.742, p < 0.001) followed by Mild (0.635, p < 0.001) and severe group (0.592, p = 0.033), while there was no correlation in Trace TR group (0.308, p = 0.076). Multivariate logistic regression showed three significant independent echocardiography predictors of high-risk precapillary PH: RVD/LVD ratio (OR = 5.734; 95%CI1.502-21.889, p = 0.011), RA area (OR 1.054; 95% CI 1.004-1.107, p = 0.035) and systolic annular tissue velocity of the lateral tricuspid annulus (S') (OR 0.735, 95% CI 0.569-0.949, p = 0.018).
Precapillary PH was not necessarily accompanied by significant TR. None or Trace TRaccounted for 26% in our population and TR-sPAP was not applicable to estimate PAP in these patients. RVD/LVD ratio, RA area and S' can independently predict the high-risk patients with precapillary PH. TR may play an indirect role in risk stratification by affecting these indicators.
在毛细血管前肺动脉高压（PH）中，不同三尖瓣反流（TR）程度的发生率定义不明确。TR 严重程度对毛细血管前 PH 患者肺动脉压（PAP）评估和临床危险分层的影响仍不清楚。
共纳入 207 例在 3 天内接受右心导管检查（RHC）和超声心动图检查的毛细血管前 PH 患者。TR 严重程度分为微量、轻度、中度和重度。采用 Pearson 相关分析评估不同 TR 程度组中超声心动图估测的收缩期 PAP（sPAP）与 RHC 测量的平均 PAP（mPAP）之间的相关性。采用 logistic 回归分析评估影响毛细血管前 PH 危险分层的因素。
无、微量、轻度、中度和重度 TR 组的比例分别为 2.4%、23.7%、39.1%、28.5%和 6.3%。右心房（RA）面积随 TR 加重而逐渐增大（p<0.001）。中度和重度 TR 组的 N 末端脑钠肽前体（p<0.001）、右心房压（RAP）（p=0.018）、右心室基底部直径/左心室基底部直径（RVD/LVD）比值（p<0.001）、右心室（RV）更大（p<0.001）和三尖瓣环收缩期位移（TAPSE）更小（p=0.006）均高于微量和轻度 TR 组。中度 TR 组的 TR-sPAP 与 mPAP 的相关系数最大（0.742，p<0.001），其次是轻度 TR 组（0.635，p<0.001）和重度 TR 组（0.592，p=0.033），而微量 TR 组无相关性（0.308，p=0.076）。多变量 logistic 回归显示，三个显著的独立超声心动图预测指标与高危毛细血管前 PH 相关：RVD/LVD 比值（OR=5.734；95%CI 1.502-21.889，p=0.011）、RA 面积（OR 1.054；95%CI 1.004-1.107，p=0.035）和外侧三尖瓣环收缩期组织速度（S'）（OR=0.735，95%CI 0.569-0.949，p=0.018）。
毛细血管前 PH 不一定伴有明显的 TR。在我们的人群中，无或微量 TR 占 26%，TR-sPAP 不适用于这些患者的 PAP 评估。RVD/LVD 比值、RA 面积和 S'可独立预测高危毛细血管前 PH 患者。TR 可能通过影响这些指标间接参与危险分层。
