Tricuspid Regurgitation Velocity Unreliable Indicator of Pulmonary Hypertension

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In patients with no reported tricuspid regurgitation velocity, pulmonary hypertension was associated with higher BMI, higher brain natriuretic peptide levels, diabetes, and heart failure.
In patients with no reported tricuspid regurgitation velocity, pulmonary hypertension was associated with higher BMI, higher brain natriuretic peptide levels, diabetes, and heart failure.

Almost half of patients who underwent right heart catheterization without a measurable tricuspid regurgitation velocity (TRV) also presented with pulmonary hypertension (PH), and therefore, its absence is not a reliable predictor of the condition, according to the results of a recent study published in the Journal of the American Heart Association

Deidentified data from patients who were referred for right heart catheterization at Vanderbilt University in Nashville, Tennessee, were categorized into 1 of 2 groups, depending on the presence or absence of a reported TRV after transthoracic echocardiography (TTE). Researchers noted that since TRV is routinely measured at their institution “the absence of a reported TRV is consistent with an unmeasurable signal.” The prevalence of PH (defined as mean pulmonary artery pressure ≥25 mm Hg) was then compared between groups to determine the usefulness of TRV as a predictor of PH.

Of the1262 patients with TTE data available, 64% had a measurable TRV, whereas 36% were not measurable. PH was confirmed by invasive methods in 47% of patients without a measurable TRV, and 68% of patients with a measurable TRV (P <.001).

Furthermore, in patients with no reported TRV, PH was associated with higher body mass index (odds ratio [OR], 1.88; 95% CI, 1.44-2.46), higher brain natriuretic peptide levels (OR, 1.32; 95% CI, 1.03-1.71), diabetes (OR, 1.88; 95% CI, 1.04-3.39), and heart failure (OR, 2.00; 95% CI, 1.27-3.13).

In addition, there was a higher prevalence of both right ventricle dilation and right ventricle dysfunction in patients with reported TRV compared with patients without measurable TRV (32% vs 15% and 34% vs 17%, respectively; P <.001).

The study authors wrote, "The absence of a TRV on TTE does not reliably exclude PH in patients referred for [right heart catheterization]. In patients with suspected PH, invasive assessment should be considered in patients without a reported TRV in the presence of [right ventricle] dysfunction."

They added, "These findings are important to patients and their physicians because they confirm that the lack of a measurable TRV does not signify normal pulmonary pressure."

Reference

O'Leary JM, Assad TR, Xu M, et al. Lack of a tricuspid regurgitation Doppler signal and PH by invasive measurement [published June 30, 2018]. J Am Heart Assoc. doi:10.1161/JAHA.118.009362

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