Document Detail

Functional tricuspid regurgitation in patients with pulmonary hypertension: is pulmonary artery pressure the only determinant of regurgitation severity?
MedLine Citation:
PMID:  18719061     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulmonary hypertension is a common cause of functional tricuspid regurgitation (TR), but other factors play a role in determining TR severity. The objectives of our study were to determine the distribution of TR severity in relation to pulmonary artery systolic pressure (PASP) and to define the determinants of TR severity. METHODS: The echocardiographic reports and selected echocardiographic studies of patients with echocardiographic estimation of PASP were reviewed. Patients with organic tricuspid valve (TV) disease were excluded from the analysis. RESULTS: Among 2,139 patients, the frequency of moderate or severe TR was progressively greater in patients with higher PASP. Nevertheless, TR was only mild in a substantial proportion of patients with high PASP (mild TR in 65.4% of patients with PASP 50-69 mm Hg and in 45.6% of patients with PASP >or= 70 mm Hg). By multivariate analysis, age, female gender, PASP (odds ratio, 2.26 per 10-mm Hg increase; 95% confidence interval, 1.95 to 2.61), pacemaker lead, right atrial (RA) and right ventricular enlargement, left atrial enlargement, and organic mitral valve disease were independently associated with greater degrees of TR. In patients with PASP >or= 70 mm Hg, RA size, tricuspid annular diameter, and TV tethering area were greater in patients with greater degrees of TR. CONCLUSIONS: PASP is a strong determinant of TR severity, but many patients with pulmonary hypertension do not exhibit significant TR. In addition to PASP, demographic characteristics, mechanical factors, remodeling of the right heart cavities, and other factors (possibly reflecting the presence of atrial fibrillation or occult organic TV disease) are predictive of TR severity.
Diab Mutlak; Doron Aronson; Jonathan Lessick; Shimon A Reisner; Salim Dabbah; Yoram Agmon
Publication Detail:
Type:  Journal Article     Date:  2008-08-21
Journal Detail:
Title:  Chest     Volume:  135     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-12     Completed Date:  2009-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-21     Citation Subset:  AIM; IM    
Department of Cardiology, Echocardiography Laboratory and Heart Valves Clinic, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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MeSH Terms
Aged, 80 and over
Blood Pressure / physiology
Cohort Studies
Hypertension, Pulmonary / complications,  physiopathology*,  ultrasonography
Middle Aged
Predictive Value of Tests
Pulmonary Artery / physiopathology*
Retrospective Studies
Risk Factors
Severity of Illness Index
Tricuspid Valve Insufficiency / etiology*,  physiopathology*,  ultrasonography

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