Vera Fortmeier1, Mark Lachmann2, Maria I Körber3, Matthias Unterhuber4, Moritz von Scheidt5, Elena Rippen2, Gerhard Harmsen6, Muhammed Gerçek1, Kai Peter Friedrichs1, Fabian Roder1, Tanja K Rudolph1, Shinsuke Yuasa7, Michael Joner5, Karl-Ludwig Laugwitz2, Stephan Baldus3, Roman Pfister3, Philipp Lurz7, Volker Rudolph8. 1. Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. 2. First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany. 3. Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany. 4. Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. 5. German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany; Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany. 6. Department of Physics, University of Johannesburg, Auckland Park, South Africa. 7. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 8. Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Electronic address: vrudolph@hdz-nrw.de.
Abstract
OBJECTIVES: This study aimed to improve echocardiographic assessment of pulmonary hypertension (PH) in patients presenting with severe tricuspid regurgitation (TR). BACKGROUND: Echocardiographic assessment of PH in patients with severe TR carries several pitfalls for underestimation, hence concealing the true severity of PH in very sick patients in particular, and ultimately obscuring the impact of PH on survival after transcatheter tricuspid valve intervention (TTVI). METHODS: All patients in this study underwent TTVI for severe TR between 2016 and 2020. To predict the mean pulmonary artery pressure (mPAP) solely based on echocardiographic parameters, we trained an extreme gradient boosting (XGB) algorithm. The derivation cohort was constituted by 116 out of 162 patients with both echocardiography and right heart catheterization data, preprocedurally obtained, from a bicentric registry. Moreover, 142 patients from an independent institution served for external validation. RESULTS: Systolic pulmonary artery pressure was consistently underestimated by echocardiography in comparison to right heart catheterization (40.3 ± 15.9 mm Hg vs 44.1 ± 12.9 mm Hg; P = 0.0066), and the assessment was most discrepant among patients with severe defects of the tricuspid valve and impaired right ventricular systolic function. Using 9 echocardiographic parameters as input variables, an XGB algorithm could reliably predict mPAP levels (R = 0.96, P < 2.2 × 10-16). Moreover, patients with elevations in predicted mPAP levels ≥29.9 mm Hg showed significantly reduced 2-year survival after TTVI (58.3% [95% CI: 41.7%-81.6%] vs 78.8% [95% CI: 68.7%-90.5%]; P = 0.026). Importantly, the poor prognosis associated with elevation in predicted mPAP levels was externally confirmed (HR for 2-year mortality: 2.9 [95% CI: 1.5-5.7]; P = 0.002). CONCLUSIONS: PH in patients with severe TR can be reliably assessed based on echocardiographic parameters in conjunction with an XGB algorithm, and elevations in predicted mPAP levels translate into increased mortality after TTVI.
OBJECTIVES: This study aimed to improve echocardiographic assessment of pulmonary hypertension (PH) in patients presenting with severe tricuspid regurgitation (TR). BACKGROUND: Echocardiographic assessment of PH in patients with severe TR carries several pitfalls for underestimation, hence concealing the true severity of PH in very sick patients in particular, and ultimately obscuring the impact of PH on survival after transcatheter tricuspid valve intervention (TTVI). METHODS: All patients in this study underwent TTVI for severe TR between 2016 and 2020. To predict the mean pulmonary artery pressure (mPAP) solely based on echocardiographic parameters, we trained an extreme gradient boosting (XGB) algorithm. The derivation cohort was constituted by 116 out of 162 patients with both echocardiography and right heart catheterization data, preprocedurally obtained, from a bicentric registry. Moreover, 142 patients from an independent institution served for external validation. RESULTS: Systolic pulmonary artery pressure was consistently underestimated by echocardiography in comparison to right heart catheterization (40.3 ± 15.9 mm Hg vs 44.1 ± 12.9 mm Hg; P = 0.0066), and the assessment was most discrepant among patients with severe defects of the tricuspid valve and impaired right ventricular systolic function. Using 9 echocardiographic parameters as input variables, an XGB algorithm could reliably predict mPAP levels (R = 0.96, P < 2.2 × 10-16). Moreover, patients with elevations in predicted mPAP levels ≥29.9 mm Hg showed significantly reduced 2-year survival after TTVI (58.3% [95% CI: 41.7%-81.6%] vs 78.8% [95% CI: 68.7%-90.5%]; P = 0.026). Importantly, the poor prognosis associated with elevation in predicted mPAP levels was externally confirmed (HR for 2-year mortality: 2.9 [95% CI: 1.5-5.7]; P = 0.002). CONCLUSIONS: PH in patients with severe TR can be reliably assessed based on echocardiographic parameters in conjunction with an XGB algorithm, and elevations in predicted mPAP levels translate into increased mortality after TTVI.
Authors: Mark Lachmann; Elena Rippen; Tibor Schuster; Erion Xhepa; Moritz von Scheidt; Teresa Trenkwalder; Costanza Pellegrini; Tobias Rheude; Amelie Hesse; Anja Stundl; Gerhard Harmsen; Shinsuke Yuasa; Heribert Schunkert; Adnan Kastrati; Karl-Ludwig Laugwitz; Michael Joner; Christian Kupatt Journal: Open Heart Date: 2022-10