García-Ribas, CoraBle, MireiaGómez Pérez, Miguel AngelMas Stachurska, AleksandraFarré López, NúriaCladellas Capdevila, M.Mercedes2022-07-282022-07-282021Garcia-Ribas C, Ble M, Gómez M, Mas-Stachurska A, Farré-López N, Cladellas M. Importance of tricuspid regurgitation velocity threshold in risk assessment of pulmonary hypertension-long-term outcome of patients submitted to aortic valve replacement. Front Cardiovasc Med. 2021 Nov 10; 8: 720643. DOI: 10.3389/fcvm.2021.7206432297-055Xhttp://hdl.handle.net/10230/53869Background: the upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s). Methods: four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm2 and right ventricle/left ventricle ratio>1 as additional echocardiographic variables. Results: in patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, p = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, p = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 p = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, p = 0.07) for guidelines threshold. Conclusion: A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.application/pdfengCopyright © 2021 Garcia-Ribas, Ble, Gómez, Mas-Stachurska, Farré-López and Cladellas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) http://creativecommons.org/licenses/by/4.0/. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.info:eu-repo/semantics/articlehttp://dx.doi.org/10.3389/fcvm.2021.720643Aortic stenosis (AS)EchocardiographyLeft heart valve diseasePulmonary hypertensionTricuspid regurgitation thresholdinfo:eu-repo/semantics/openAccess