Prognostic Value of Tricuspid Regurgitation in Pulmonary Hypertension and Among the Different WHO Groups.

BACKGROUND

Secondary tricuspid regurgitation (STR) is frequently observed in patients with pulmonary hypertension (PH). Whether it independently confers mortality risk beyond the associated right ventricular (RV) dysfunction remains unknown.

OBJECTIVES

The aim of this study was to evaluate the prognostic significance of STR in patients with PH other than related to left-sided valve disease or reduced ejection fraction and across the individual WHO (World Health Organization) groups of PH.

METHODS

Patients with RV systolic pressures ≥50 mm Hg on echocardiography between 2010 and 2023 and measured RV free wall longitudinal strain were identified retrospectively. Primary tricuspid valve disease, reduced left ventricular ejection fraction, significant left-sided valve disease, congenital heart disease, decompensated cirrhosis, malignancy, and dialysis were exclusion criteria. PH was classified according to the WHO group classification. Patients were followed for all-cause mortality.

RESULTS

Of 1,318 patients (mean age 67 years, 61% women, 29% with moderate or greater STR, median RV free wall longitudinal strain 19%), WHO groups 1, 2, 3, and 4 PH were present in 33%, 11%, 32%, and 12%, respectively. Patients with moderate or greater STR were more symptomatic and congested and had worse RV function and pulmonary pressures. Over a median 1.5 years (Q1-Q3: 0.3-4.6 years), 454 patients died. Moderate or severe STR was associated with mortality independent of various RV function measures or RV-pulmonary arterial coupling. This remained true across the individual WHO groups of PH.

CONCLUSIONS

Moderate or severe STR conferred mortality risk in patients with PH without left-sided valve disease or reduced left ventricular ejection fraction, beyond what can be explained by the associated RV dysfunction or impaired RV-pulmonary arterial coupling. Whether STR may represent an additional therapeutic target in certain subgroups with PH requires future investigation.