ORIGINAL INVESTIGATION

Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation

Corresponding Author

Francisco Gual-Capllonch MD

[email protected]

orcid.org/0000-0002-5144-9081

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Correspondence: Francisco Gual-Capllonch, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916. Badalona (Barcelona), Spain ([email protected]).Search for more papers by this author

Albert Teis MD,

Albert Teis MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Elena Ferrer MD,

Elena Ferrer MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Julio Núñez MD, PhD,

Julio Núñez MD, PhD

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Cardiology Department, Hospital Clínico Universitario, INCLIVA Valencia, Valencia, Spain

Department of Medicine, Universidad de Valencia, Valencia, Spain

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Nuria Vallejo MD,

Nuria Vallejo MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Gladys Juncà MD,

Gladys Juncà MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Jorge López-Ayerbe MD,

Jorge López-Ayerbe MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Josep Lupón MD, PhD,

Josep Lupón MD, PhD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

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Antoni Bayes-Genis MD, PhD,

Antoni Bayes-Genis MD, PhD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

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Francisco Gual-Capllonch MD,

Corresponding Author

Francisco Gual-Capllonch MD

[email protected]

orcid.org/0000-0002-5144-9081

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Albert Teis MD,

Albert Teis MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Search for more papers by this author

Elena Ferrer MD,

Elena Ferrer MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Search for more papers by this author

Julio Núñez MD, PhD,

Julio Núñez MD, PhD

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Cardiology Department, Hospital Clínico Universitario, INCLIVA Valencia, Valencia, Spain

Department of Medicine, Universidad de Valencia, Valencia, Spain

Search for more papers by this author

Nuria Vallejo MD,

Nuria Vallejo MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Search for more papers by this author

Gladys Juncà MD,

Gladys Juncà MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Search for more papers by this author

Jorge López-Ayerbe MD,

Jorge López-Ayerbe MD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Search for more papers by this author

Josep Lupón MD, PhD,

Josep Lupón MD, PhD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

Search for more papers by this author

Antoni Bayes-Genis MD, PhD,

Antoni Bayes-Genis MD, PhD

Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

CIBERCV, Instituto de Salud Carlos III, Madrid, Spain

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

Search for more papers by this author

First published: 23 August 2018

https://doi.org/10.1111/echo.14125

Citations: 7

Funding information

This research was supported by grants from the Ministerio de Educación y Ciencia (AB-G, SAF2014-59892), Fundació La MARATÓ de TV3 (AB-G, 201502, 201516), CIBER Cardiovascular (AB-G, CB16/11/00403), and AdvanceCat 2014-2020 (AB-G), CIBER CV (JN, 16/11/00420), FEDER and PIE (JN, 15/00013).

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Abstract

Background

Pulmonary hypertension (PH) is a common cause of right ventricular (RV) remodeling and functional tricuspid regurgitation (FTR), but incremental pulmonary artery systolic pressure (PASP) does not always correlate with anatomic and functional RV changes. This study aimed to evaluate a noninvasive measure of pulmonary vascular resistance (PVR) for predicting RV dilatation, RV dysfunction, and severity of FTR.

Methods

We prospectively analyzed consecutive stable patients with PASP ≥ 35 mm Hg or any degree of RV dilatation or dysfunction secondary to PH. Noninvasive PVR was calculated based on FTR peak velocity and flow in RV outflow tract.

Results

We included 251 patients, aged 72.1 ± 11.4 years, 53% women, 74.9% with type 2 pulmonary hypertension. The mean PASP was 48.3 ± 12.2 mm Hg. Both PASP and PVR significantly correlated with FTR, RV dilatation, and RV systolic dysfunction. After dichotomizing FTR and RV dilatation and systolic dysfunction as nonsignificant vs significant, FTR and RV dilatation were similarly predicted by PASP and PVR, but RV dysfunction was better predicted by PVR (AUC = 0.78 [0.72–0.84] vs 0.66 [0.60–0.73] for PASP, P < 0.001). Patients with low PASP but high PVR showed worse RV and left ventricular function but lower rates of right heart failure and smaller inferior vena cava, compared to patients with high PASP but low PVR.

Conclusions

Noninvasive PVR was superior to PASP for predicting RV systolic dysfunction, but both were similarly associated with RV dilatation or FTR grade. PASP and PVR complement each other to define the echocardiographic findings and clinical status of the patient.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

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Citing Literature

Volume35, Issue11

November 2018

Pages 1736-1745

Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Information

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Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Related

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