How Good Is Tricuspid Regurgitation Velocity in Excluding Pulmonary Hypertension in Patients with Left Heart Disease

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Background: Pulmonary hypertension (PH) is defined as mean pulmonary artery pressure (mPAP) >25 mmHg. Patients undergoing cardiac surgery have increased mortality if they have significant PH, defined as systolic pulmonary artery pressure (sPAP) >60 mmHg. Our aim was to see if measurement of tricuspid regurgitant velocity (TRVmax) by Doppler echocardiography can exclude PH. Methods: Patients having a transthoracic echocardiogram (TTE) and right heart catheterisation (RHC) within three days of each other were reviewed. TRVmax < 2.8 m/s was used as a cut-off to exclude PH as recommended by ESC guidelines for PH. Results: From January 2004 to February 2011, 693 patients had RHC before cardiac surgery. Out of these, 159 patients had TTE within three days of RHC and were used for analysis. Prevalence of PH was 51% in this group. TRVmax was measured in 99(62%) out of 159 patients. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for diagnosis of PH (mPAP > 25mmHg) were 66%, 83%, 65% and 84% respectively. Sensitivity, specificity, NPV and PPV for diagnosis of significant PH (sPAP > 60 mmHg) were 80%, 64%, 93% and 36% respectively. TRVmax was not measurable in 60 (38%) patients due to no tricuspid regurgitation (TR) or trace TR. Absent/trace TR had a 50% NPV to exclude diagnosis of PH and 93% NPV to exclude significant PH. Conclusion: TRVmax < 2.8 m/s has a low sensitivity (66%) and NPV (65%) for diagnosis of PH, but high sensitivity (80%) and NPV (93%) to exclude significant PH. Absent/trace TR has low NPV (50%) for diagnosis of PH but high NPV (93%) to exclude significant PH.