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Research ArticleOriginal Article
Open Access

Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension

A comprehensive study

Jamilah S. AlRahimi, Yasser M. Ismail, Noor A. Aljubairi, Nawal W. Kutob, Ghadi S. Bakulka, Ruqayyah A. Ahmed, Fatima A. Ahmed and Ali A. Haneef
Saudi Medical Journal June 2024, 45 (6) 572-577; DOI: https://doi.org/10.15537/smj.2024.45.6.20240071
Jamilah S. AlRahimi
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
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Yasser M. Ismail
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
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Noor A. Aljubairi
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
Roles: Medical Technologist
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Nawal W. Kutob
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
Roles: Medical Technologist
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Ghadi S. Bakulka
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
Roles: Medical Technologist
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Ruqayyah A. Ahmed
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
Roles: Medical Student
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Fatima A. Ahmed
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
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Ali A. Haneef
From the Department of Cardiology (AlRahimi, Ismail, Ahmed, Haneef); from the Department of Cardiothoracic Surgery (Haneef), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from King Abdullah International Medical Research Center (AlRahimi, Ismail, Aljubairi, Kutob, Bakulka), from the College of Medicine (AlRahimi); from the College of Applied Medical Sciences (Ismail, Aljubairi, Kutob, Bakulka), King Saud bin Abdulaziz University for Health Sciences, and from the College of Medicine (Ahmed), Batterjee Medical College for Science and Technology, Jeddah, Kingdom of Saudi Arabia.
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  • For correspondence: [email protected]
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    Table 1

    - Demographic and clinical characteristics of adult patients with pulmonary hypertension (N=118).

    Patient’s characteristicsn (%)
    Age (years), mean±SD59.73±18.86
    Female100 (84.7)
    Body mass index
    Underweight4 (3.4)
    Normal27 (22.9)
    Overweight30 (25.4)
    Obese57 (48.3)
    Marital status
    Single19 (16.1)
    Married99 (83.9)
    Ischemic heart disease17 (14.4)
    Mitral stenosis7 (5.9)
    Mitral regurgitation97 (82.2)
    Ejection fraction >55%86 (72.9)
    Chronic obstructive pulmonary disease9 (7.6)
    Diabetes mellitus50 (42.4)
    Hypertension66 (55.9)
    • Values are presented as numbers and percentages (%) or mean ± standard deviation (SD).

    • View popup
    Table 2

    - Clinical and echocardiographic data according to the degree of tricuspid regurgitation.

    VariablesTrivial TR (n=14)Mild TR (n=41)Moderate TR (n=25)Severe TR (n=26)Massive TR (n=2)Torrential TR (n=10)P-values
    Age (years), mean±SD61.29±15.7058.44±20.4062.92±19.4661.62±17.6332.50±2.1255.40±17.530.314
    sPAP(mmHg), mean±SD45.99±22.8052.44±12.6361.45±16.9167.08±14.8782.80±10.0469.41±25.64<0.001
    mPAP(mmHg), mean±SD36.09±6.6933.42±11.6334.48±12.1835.52±9.2959.00±6.6533.30±13.390.029
    PR
    None8 (57.1)14 (34.1)11 (44.0)3 (11.5)-3 (30.0)0.025
    Trace2 (14.3)15 (36.6)7 (28.0)6 (23.1)-1 (10.0)
    Mild2 (14.3)10 (24.4)7 (28.0)14 (53.8)1 (50.0)4 (40.0)
    Moderate2 (14.3)2 (4.9)-3 (11.5)1 (50.0)2 (20.0)
    RA size
    Normal11 (78.6)28 (68.3)17 (68.0)5 (19.2)-2 (20.0)<0.001
    Mildly dilated3 (21.4)10 (24.4)5 (20.0)8 (30.8)1 (50.0)1 (10.0)
    Moderately dilated-3 (7.3)3 (12.0)7 (26.9)-3 (30.0)
    Severely dilated---6 (23.1)1 (50.0)4 (40.0)
    RV size
    Normal8 (57.1)32 (78.0)17 (68.0)9 (34.6)-3 (30.0)0.001
    Mildly dilated4 (28.6)5 (12.2)5 (20.0)5 (19.2)1 (50.0)3 (30.0)
    Moderately dilated1 (7.1)4 (9.8)3 (12.0)9 (34.6)-1 (10.0)
    Severely dilated1 (7.1)--3 (11.5)1 (50.0)3 (30.0)
    RV function
    Normal12 (85.7)39 (95.1)21 (84.0)12 (46.1)1 (50.0)3 (30.0)<0.001
    Mildly impaired1 (7.1)2 (4.9)2 (8.0)6 (23.1)1 (50.0)5 (50.0)
    Moderately impaired1 (7.1)-2 (8.0)7 (26.9)-2 (20.0)
    Severely impaired---1 (3.8)--
    EF%
    40-55%3 (21.4)10 (24.4)3 (12.0)15 (57.7)-1 (10.0)0.005
    >55%11 (78.6)31 (75.6)22 (88.0)11 (42.3)2 (100.0)9 (90.0)
    RVs’ (cm/s), mean±SD12.28±3.2012.14±2.6911.35±2.299.90±2.3812.75±3.189.20±2.450.002
    TAPSE (cm), mean±SD1.98±0.471.97±0.371.85±0.261.77±0.551.60±0.421.64±0.410.063
    E/e’, mean±SD13.63±19.7612.19±6.2511.70±6.2514.00±9.777.90±3.6813.10±13.180.548
    • Values are presented as numbers and percentages (%) or mean ± standard deviation (SD).

    • TR: tricuspid regurgitation, sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure, PR: pulmonary regurgitation, RA: right atrium, RV: right ventricle, EF: ejection fraction, RV’s: right ventricular systolic velocity, TAPSE: tricuspid annular plane systolic excursion, E/e’: left atrium filling pressure

    • View popup
    Table 3

    - Systolic and mean pulmonary artery pressure in patients with different grades of right ventricular dilatation and hypofunction.

    RV sizeNormal RV size (n=69)Mild RV dilatation (n=23)Moderate RV dilatation (n=18)Severe RV dilatation (n=8)P-values
    sPAP (mmHg)52±1364±2168±2173±34<0.001
    mPAP (mmHg)28±1238±1339±1036±170.002
    RV functionNormal RV function (n=88)Mildly impaired (n=17)Moderately impaired (n=12)Severely impaired (n=1)P-values
    sPAP (mmHg)55±1870±2162±22720.015
    mPAP (mmHg)31±1439±1232±7350.193
    • Values are presented as mean ± standard deviation (SD). mPAP: mean pulmonary artery pressure, RV: right ventricle, sPAP: systolic pulmonary artery pressure

    • View popup
    Table 4

    - Factors associated with systolic and mean pulmonary artery pressure.

    Variablesβ (95% CI)P-values
    Mean pulmonary artery pressure
    Right ventricle dilatation3.55 (1.09-6.03)0.005
    Pulmonary valve regurgitation2.67 (0.24-5.11)0.031
    Systolic pulmonary artery pressure
    Tricuspid regurgitation4.14 (1.49-6.78)0.002
    Right atrial dilatation5.51 (1.97-9.05)0.003
    • Values are presented as beta and 95% confidence interval (CI).

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Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension
Jamilah S. AlRahimi, Yasser M. Ismail, Noor A. Aljubairi, Nawal W. Kutob, Ghadi S. Bakulka, Ruqayyah A. Ahmed, Fatima A. Ahmed, Ali A. Haneef
Saudi Medical Journal Jun 2024, 45 (6) 572-577; DOI: 10.15537/smj.2024.45.6.20240071

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Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension
Jamilah S. AlRahimi, Yasser M. Ismail, Noor A. Aljubairi, Nawal W. Kutob, Ghadi S. Bakulka, Ruqayyah A. Ahmed, Fatima A. Ahmed, Ali A. Haneef
Saudi Medical Journal Jun 2024, 45 (6) 572-577; DOI: 10.15537/smj.2024.45.6.20240071
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Keywords

  • pulmonary hypertension
  • tricuspid regurgitation
  • right ventricular dilatation
  • right ventricular dysfunction
  • right atrial dilatation

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