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Purpose: Elevated pulmonary arterial systolic pressure (PASP) is known to cause functional tricuspid regurgitation (TR). In pulmonary arterial hypertension (PH), a significant degree of TR is related with worse outcome. However the differential contribution of pressure load and right ventricular dilation has not been established yet. We aimed at evaluating both variables related with TR.Methods: We conducted in a larger database project a cross-sectional study of consecutive transthoracic echocardiographic studies of patients followed at our institution with PH. Of these patients demographic data (age, gender) as well as echocardiographic 2D and Doppler right ventricular parameters were collected from November 1st 2010 until January 6th 2011. TR was graded in a semi-quantitative manner from 0 to a maximum of 4 out of 4. Right ventricular dilation was defined as no, mild, moderate and severe. Pearson's correlation coefficients between the different obtained parameters and TR were calculated. To assess independence between parameters, multivariate linear regression analysis of the significantly correlated parameters was done.Results: Eighty-two patients (32.9% male; mean age of 61±15) years with PH (46.3% Group 1; 0% Group 2; 45.1% Group 4; 2.4% Group 5 according to the 2009 DANA POINT classification of PH) were evaluated. Significant correlations were found between TR and PASP (0.547; p<0.001), Pulmonary Acceleration Time (PAT) (-0.367; p=0.001), right ventricular dilation (0.643; p<0.001), and Vena Cava Inferior diameter measured at inspiration (0.435; p<0.001). In the multivariate analysis, only right ventricular dilation (p=0.002) and PASP(p=0.009) were independently correlated with the degree of TR.Conclusion: These echocardiographic findings suggest that not only PASP, but also right ventricular dilation itself are independently related to increasing severity of TR. Therefore it is plausible that, when focussing on the severity of TR to improve prognosis in patients with PH, the PASP as well as the right ventricular dimensions should be targeted.