Study supports slower tricuspid regurgitation rate for screening for pulmonary hypertension


23 December 2021

2 minutes to read

Source / Disclosures

Disclosures: Montané does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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New data published in VSIt is support a lower tricuspid regurgitation rate of 2.7 m per second for screening for pulmonary hypertension.

To assess the likelihood of pulmonary hypertension, the guidelines of the European Respiratory Society and the European Society of Cardiology recommend tricuspid regurgitation rate thresholds of 2.8 m per second and 3.4 m per second, as well. than an additional size of the right heart chamber.

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“Recently, the Sixth World Symposium on Pulmonary Hypertension recommended that the hemodynamic threshold for the diagnosis of pulmonary hypertension be lowered, based on normative data which shows that the upper limit of normal mean pulmonary arterial pressure is 20 mm Hg and increased deaths in patients with mean pulmonary arterial pressure between 20 and 24 mm Hg ”, Bryce E. Montané, MARYLAND, internist in the department of internal medicine at the Cleveland Clinic, and colleagues have written. “With the new definition of pulmonary hypertension, we hypothesized that lower thresholds for tricuspid regurgitation rate and assessment of right cardiac chamber size could be used to improve detection of pulmonary hypertension. . “

The multicenter retrospective study included 1,608 patients who underwent echocardiography and right cardiac catheterization within 4 weeks from 1996 to 2019 (considered the discovery cohort) and from 2000 to 2018 (considered the validation cohort). The discovery cohort consisted of 1,081 patients (mean age 57.8 years; 63.3% female) and the validation cohort consisted of 527 patients (mean age 52.5 years; 49.1% female).

The primary outcome measure was the presence of pulmonary hypertension, defined as an average pulmonary arterial pressure greater than 20 mm Hg by right cardiac catheterization.

The researchers reported that, in the discovered cohort, the echocardiographic tricuspid regurgitation rate discriminated well for pulmonary hypertension (area under the curve, 88.4).

Using the threshold of 3.4 m per second gave a sensitivity of 78%, a specificity of 87% and a positive likelihood ratio of 6.13 for the detection of pulmonary hypertension in the discovery cohort, according to the results. Using the threshold of 2.7 m per second gave a sensitivity of 95% and a negative odds ratio of 0.12 for exclusion of pulmonary hypertension.

In the validation cohort, using the cutoff of 2.7 m per second gave a sensitivity of 80% and a negative likelihood ratio of 0.31 to rule out pulmonary hypertension. Additionally, the researchers observed that right heart size improved detection of pulmonary hypertension in patients in the lower tricuspid regurgitation rate groups.

“Our aggregated data suggests a lower tricuspid regurgitation rate threshold of 2.7 m / s for screening for pulmonary hypertension,” the researchers wrote. “In addition, our study supports current guidelines; the size of the right cardiac chamber, when used in combination with the tricuspid regurgitation rate, may improve the likelihood assessment for the diagnosis of pulmonary hypertension, especially in patients with tricuspid regurgitation rate weaker.


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