P641Usefulness of pulmonary vascular resistance over pulmonary artery pressure to predict right ventricular remodeling and functional tricuspid regurgitation

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Background: Pulmonary artery pressure depends on pulmonary vascular resistance (PVR) and cardiac flow, and its elevation does not always correlate properly with increasing degrees of right ventricular (RV) remodeling or functional tricuspid regurgitation (TR). We evaluated whether a non-invasive measure of PVR is better than systolic pulmonary artery pressure (sPAP) to predict RV dilatation, RV dysfunction and degree of TR.Methods: We prospectively analyzed consecutive stable patients with TR and a Doppler estimation of sPAP ≥ 35 mmHg or any degree of RV dilatation or RV dysfunction. We excluded patients with organic TR, pacemaker leads, primary RV dilatation or dysfunction and intracardiac shunts. Non-invasive PVR was measured as the quotient between TR velocity and RV outflow tract flow (VTI).Results: We included 255 patients, age 72,1± 11,4 years-old, 52% women, 76,1% with type 2 pulmonary hypertension, and 38% in atrial fibrillation. Mean sPAP was 48,6±13,2 mmHg. RV dilatation was mild, moderate and severe in 35,7%, 15,3% and 2,0%, respectively. TR was graded in four categories: mild in 48,2% of patients, mild-moderate in 34,1%, moderate-severe in 15,3% and severe in 2,4%. RV systolic function was measured by TAPSE (mean 20,1±4,9mm). In univariate analysis, sPAP was associated with RV dilatation (r=0,62), degree of TR (r=0,55) and RV systolic function (r=-0,27) (all p<0,001). PVR was similarly associated with RV dilatation (r=0,59) and degree of TR (r=0,50), and had a stronger correlation with RV systolic function (r=-0,51) compared to sPAP (all p<0,001). In multivariate analysis, sPAP was an independent predictor of RV dilatation and TR severity, while PVR was an independent predictor of RV dilatation, TR severity and RV systolic function.Conclusion: Non-invasive PVR measurement is superior to sPAP for the prediction of RV systolic dysfunction, but it does not confer additional value to predict RV dilatation or TR severity.

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