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Original research
Echocardiographic estimation of pulmonary pressure in patients with severe tricuspid regurgitation
  1. Léo Lemarchand,
  2. Vincent Auffret,
  3. Hervé Le Breton,
  4. Marc Bedossa,
  5. Dominique Boulmier,
  6. Elena Galli,
  7. Erwan Donal,
  8. Guillaume Leurent
  1. Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
  1. Correspondence to Dr Guillaume Leurent, Cardiology, Pontchaillou Hospital Cardiology and Vascular Diseases Department, Rennes 35000, France; Guillaume.LEURENT{at}; Dr Léo Lemarchand; leo.lem{at}


Objectives The estimation of systolic pulmonary artery pressure (sPAP) by transthoracic echocardiography (TTE) is challenging in patients with severe tricuspid regurgitation (TR). The study aimed to determine the reliability of the assessment of sPAP by TTE in this population.

Methods This study was a single-centre analysis of consecutive patients at the University Hospital of Rennes with right heart catheterisation and TTE, performed with a maximum delay of 48 hours. Lin’s concordance coefficient (LCC) and Bland-Altman analysis were used to compare the values.

Results After applying the exclusion criteria, 236 patients were included in the analysis (age 71±11.5 years old; male 56%). The two principal indications were TR (34.3%) and mitral regurgitation (32.2%). The correlation between the two procedures was good in the total population (LCC=0.80; 95% limits of agreement (LOA): 0.74, 0.84), but weaker in the 78 patients (33%) with severe TR (LCC=0.67; 95% LOA: 0.49, 0.80), with a propensity to an underestimation by TTE. An elevated right atrial pressure (RAP) was associated with an underestimation by TTE of about 8 mmHg. The presence of a ‘V-wave cut-off’ sign on continuous-wave Doppler (OR=3.74; 95% CI 1.48, 9.30; p<0.01), found exclusively in patients with severe TR, was an independent predictor of sPAP misestimation by TTE.

Conclusion The reliability of the estimation of sPAP in patients with severe TR could be altered by high RAP which cannot be estimated with current thresholds.

  • Tricuspid Valve Insufficiency
  • Hypertension, Pulmonary
  • Echocardiography

Data availability statement

No data are available.

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  • Contributors LL, VA, ED and GL: conception and design and data interpretation; drafting and revising of the manuscript; final approval of the manuscript submitted. HLB, MB, DB and EG: critical review of the manuscript for important intellectual content; final approval of the manuscript submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Relationship with industry: GL reports proctoring activity, lecture and consultant fees from Abbott; VA reports lecture fees from Medtronic and BMS/Pfizer; ED reports research grants from General Electric and Abbott.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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