Severity of Tricuspid Regurgitation on the Long-term Outcomes In Patients with Group I Pulmonary Hypertension Vs. Group Ii Pulmonary Hypertension

Background Severity of tricuspid regurgitation (TR) is implicated in the prognosis of different cardiac diseases, however little is known about this association in different types of pulmonary hypertension (PH) patients. Methods Single center study where 80 patients were recruited (40 with group I PH and 40 with group II PH). Echocardiogram was performed at 6 months and 12 months intervals after starting pulmonary vasodilators. Right heart cath was done at the beginning and after 12 months follow up. RV free-wall speckle-tracking strain, s’, TAPSE were used to assess RV function. TR severity was measured by echocardiogram and confirmed by cardiac MRI. Non ischemic LGE pattern and RV insertion site LGE were assessed. Patients were followed for a total of 24 months. Results Kaplan-Meier curve showed that patients with more than moderate TR had overall worse outcomes especially in group II PH (log-rank p=0.06). There was noticeable reduction in severity of TR after starting pulmonary vasodilators in the 2 groups, however p value was not significant. RV function improved when TR severity went from severe to mild and this was confirmed both by echo and cardiac MRI especially in group II PH with p value of 0.09. The presence of LGE was associated with worse outcomes regardless of type of PH, p value was 0.001. RV free wall speckle tracking strain improved as severity of TR improves especially from severe to mild and this was mostly noticed in group II PH with overall better outcome. Conclusion Improvement of TR and RV free wall speckle tracking strain was associated with better outcomes especially in group II PH. The presence of LGE regardless of type of PH, was associated with worse outcomes in the long term.