Department of Pulmonary Medicine, PHEniX Laboratory, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands.
Eur Respir J. 2024 Jun 20;63(6). doi: 10.1183/13993003.01696-2023. Print 2024 Jun.
The consequences of tricuspid regurgitation (TR) for right ventricular (RV) function and prognosis in pulmonary arterial hypertension (PAH) are poorly described and effects of tricuspid valve repair on the RV are difficult to predict.
In 92 PAH patients with available cardiac magnetic resonance (CMR) studies, TR volume was calculated as the difference between RV stroke volume and forward stroke volume, pulmonary artery (PA) stroke volume. Survival was estimated from the time of the CMR scan to cardiopulmonary death or lung transplantation. In a subgroup, pressure-volume loop analysis including two-parallel elastances was applied to evaluate effective elastances, including net afterload (effective arterial elastance ( )), forward afterload (effective pulmonary arterial elastance ( )) and backward afterload (effective tricuspid regurgitant elastance ( )). The effects of tricuspid valve repair were simulated using the online software package Harvi.
26% of PAH patients had a TR volume ≥30 mL. Greater TR volume was associated with increased N-terminal pro-brain natriuretic peptide (p=0.018), mean right atrial pressure (p<0.001) and RV end-systolic and -diastolic volume (both p<0.001). TR volume ≥30 mL was associated with a poor event-free survival (p=0.008). In comparison to , correlated better with indices of RV dysfunction. Lower end-systolic elastance ( ) (p=0.002) and (p=0.030), higher (p=0.001) and reduced / (p<0.001) were found in patients with a greater TR volume. Simulations predicted that tricuspid valve repair increases RV myocardial oxygen consumption in PAH patients with severe TR and low unless aggressive volume reduction is accomplished.
In PAH, TR has prognostic significance and is associated with low RV contractility and RV-PA uncoupling. However, haemodynamic simulations showed detrimental consequences of tricuspid valve repair in PAH patients with low RV contractility.
三尖瓣反流（TR）对肺动脉高压（PAH）患者右心室（RV）功能和预后的影响描述甚少，而三尖瓣修复对 RV 的影响也难以预测。
在 92 例有心脏磁共振（CMR）研究的 PAH 患者中，TR 容积通过 RV 搏出量与前向搏出量的差值，即肺动脉（PA）搏出量计算得出。生存时间从 CMR 扫描到心肺死亡或肺移植的时间进行估计。在亚组中，应用包括两个并联弹性的压力-容积环分析来评估有效弹性，包括净后负荷（有效动脉弹性（ ））、前向后负荷（有效肺动脉弹性（ ））和后向后负荷（有效三尖瓣反流弹性（ ））。使用在线软件包 Harvi 模拟三尖瓣修复的效果。
26%的 PAH 患者的 TR 容积≥30ml。更大的 TR 容积与更高的 N 末端脑利钠肽前体（p=0.018）、平均右心房压力（p<0.001）和 RV 收缩末期和舒张末期容积（均 p<0.001）相关。TR 容积≥30ml 与不良无事件生存相关（p=0.008）。与 相比， 与 RV 功能障碍的指标相关性更好。在 TR 容积较大的患者中，发现更低的收缩末期弹性（ ）（p=0.002）和 （p=0.030），更高的 （p=0.001）和降低的 / （p<0.001）。模拟预测，在严重 TR 和低 且未完成积极容量减少的情况下，PAH 患者的三尖瓣修复会增加 RV 心肌耗氧量。
在 PAH 中，TR 具有预后意义，与 RV 收缩功能降低和 RV-PA 解耦相关。然而，血流动力学模拟显示，在低 RV 收缩功能的 PAH 患者中，三尖瓣修复有不利影响。
