Universität zu Köln

Fortmeier, Vera, Lachmann, Mark, Koerber, Maria, I, Unterhuber, Matthias ORCID: 0000-0002-8175-276X, von Scheidt, Moritz, Rippen, Elena, Harmsen, Gerhard, Gercek, Muhammed, Friedrichs, Kai Peter, Roder, Fabian, Rudolph, Tanja K., Yuasa, Shinsuke ORCID: 0000-0001-5593-7552, Joner, Michael, Laugwitz, Karl-Ludwig, Baldus, Stephan, Pfister, Roman, Lurz, Philipp and Rudolph, Volker (2022). Solving the Pulmonary Hypertension Paradox in Patients With Severe Tricuspid Regurgitation by Employing Artificial Intelligence. JACC-Cardiovasc. Interv., 15 (4). S. 381 - 395. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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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 x 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. (C) 2022 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fortmeier, Vera UNSPECIFIED UNSPECIFIED UNSPECIFIED Lachmann, Mark UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Maria, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Unterhuber, Matthias UNSPECIFIED orcid.org/0000-0002-8175-276X UNSPECIFIED von Scheidt, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED Rippen, Elena UNSPECIFIED UNSPECIFIED UNSPECIFIED Harmsen, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Gercek, Muhammed UNSPECIFIED UNSPECIFIED UNSPECIFIED Friedrichs, Kai Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Roder, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Yuasa, Shinsuke UNSPECIFIED orcid.org/0000-0001-5593-7552 UNSPECIFIED Joner, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Laugwitz, Karl-Ludwig UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Lurz, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-689618
DOI:	10.1016/j.jcin.2021.12.043
Journal or Publication Title:	JACC-Cardiovasc. Interv.
Volume:	15
Number:	4
Page Range:	S. 381 - 395
Date:	2022
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7605
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RIGHT-VENTRICULAR FUNCTION; ECHOCARDIOGRAPHIC-ASSESSMENT; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; REPAIR; ADULTS; IMPACT Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68961