Prognostic Implications and Reversibility of Pulmonary Vascular Resistance Derived by Echocardiography in Patients Undergoing Tricuspid Annuloplasty

Abstract Aims Pulmonary vascular resistance (PVR) intimately correlates with right ventricular afterload and the development of secondary tricuspid regurgitation (sTR). We sought to investigate the prognostic roles of PVR derived by echocardiography in patients with sTR undergoing tricuspid annuloplasty (TA). Methods and results Data from 322 TA patients [median age (inter-quartile range): 65.0 (59.0–70.0) years; 35.7% males] were obtained from a prospective registry to determine the impact of PVR on the composite outcome [including all-cause mortality and heart failure (HF) hospitalization]. PVR was calculated by dividing the peak TR velocity by time–velocity integral of the right ventricular outflow tract followed by adding 0.16. During a median follow-up of 5.2 years, 108 adverse events occurred including 48 deaths and 60 HF readmissions. Baseline PVR ≥ 2 WU was independently associated with a higher risk of composite outcome (HR: 1.674, 95% CI: 1.028–2.726, P = 0.038). Baseline PVR outperforms both pulmonary artery systolic pressure (PASP) and the ratio of tricuspid annulus plane systolic excursion to PASP in terms of outcome prediction, with pronounced improvement of global model fit, reclassification, and discrimination. In 150 patients who received short-term echocardiograms after surgery, the presence of post-operative PVR ≥ 2 WU (n = 20, 13.3%) was independently associated with the composite outcome (HR: 2.621, 95% CI: 1.292–5.319, P = 0.008). Conclusion PVR derived by echocardiography is an independent determinant of outcomes in patients undergoing TA for sTR. The inclusion of non-invasive PVR may provide valuable information to improve patient selection and post-operative management in this population.