Prognostic significance of tricuspid regurgitation peak velocity in patients with heart failure and preserved ejection fraction

Abstract

Background: In patients with heart failure and preserved ejection fraction (HF-PEF), tricuspid regurgitation peak velocity (TRPV) may help to stratify the clinical risk. Data are limited, and the purpose of this work is to investigate the prognostic significance of TRPV in HF-PEF. Methods and results: Eighty five consecutive patients with HF-PEF (Framing-ham criteria, EF > 50% and BNP > 200 pg/ml, recommendation ESC 2009) who prospectively underwent quantitative Doppler echocardiographic measurements were followed up for 12 months. Of these, 48 had an overt or suspected elevated pulmonary artery pressure [TRPV > 2.8 m/s] and 28 presented cardiac events during follow-up (readmission for heart failure or cardiac death). Ising univariate analysis, patients who had elevated TRPV exhibited more stroke (p=0.037), and anemia (p=0.024). Furthermore, they had higher transmitral early E wave peak velocity (p=0.001), transmitral E/A ratio (p=0.029), blood to tissue E/e' ratio (p=0.030), and larger left atrium (p=0.028). These patients experienced more frequently symptoms of dyspnea (p=0.006). By multivariate Cox regression analysis, independent predictors of cardiac events were as follows: an increase in mean TRPV > 2.8 m/s (ROC, sensibility 77.78, specificity 61.40, p=0.015, IC [1.50-18.73]), an history of ischemic heart disease (p=0.013, CI [1.53-35.12]), an anticoagulation therapy (p=0.033, CI [1.01-32.44]), and a smaller left ventricle end-diastolic diameter (p=0.003, CI [0.71-0.93]). Tricuspid regurgitation peak velocity provided incremental prognostic value in patients with HF-PEF (logrank p=0.015, figure 1) (figure Presented) Conclusions: Tricuspid regurgitation peak velocity could be useful to identify a high-risk subset of patients with heart failure and preserved ejection fraction.