School of Medicine, University College Dublin, Dublin, Ireland.
Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Eur Heart J Cardiovasc Imaging. 2023 Aug 23;24(9):1210-1221. doi: 10.1093/ehjci/jead070.
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.
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).
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.
三尖瓣反流（TR）是一种常见的瓣膜疾病，与死亡率增加有关。需要有工具来评估 TR 患者的肺动脉（PA）循环与右心室之间的相互作用，并研究它们与结局的关系。肺动脉搏动指数（PAPi）已成为左心疾病和肺动脉高压（PH）的血流动力学风险预测指标。PAPi 是否能区分大于或等于中度 TR 的未选择患者的风险尚不清楚。
在 5079 例大于或等于中度 TR（无论病因如何）且首次超声心动图测量到 PA 收缩压和舒张压的患者中，我们比较了根据是否存在 PH 和 PAPi 水平，在 5 年内的全因死亡率。共有 2741 例（54%）患者存在 PH。PAPi 的中位数为 3.0（IQR 1.9, 4.4）。PH 的存在和 PAPi 水平的降低与更大的右心室、更差的右心室收缩功能、更高的 NT-proBNP 水平、更大程度的右心衰竭和更差的生存有关。在一小部分在 24 小时内进行了超声心动图和右心导管检查的患者中，非侵入性与侵入性 PA 压力和 PAPi 水平的相关性非常好（r = 0.76）。
在有或没有 PH 的大于或等于中度 TR 患者中，较低的 PAPi 与右心室功能障碍、右心衰竭和更差的生存有关。无论病因如何，纳入 PA 压力和 PAPi 可能有助于对大于或等于中度 TR 患者的疾病严重程度进行分层。
