Abstract 4146849: Reassessing Thresholds for Pulmonary Hypertension in Healthy and Early Stage Heart Failure - Project Baseline Health Study

Background: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PH) may underestimate its prevalence and importance in clinical practice. Objective: To determine reference values and correlates of right ventricle systolic pressure tricuspid regurgitation (TR) velocity and (RVSP) in the Project Baseline Health Study (PBHS), with a particular focus on diastolic function and preclinical lung and heart diseases. Methods: In the PBHS, 2,082 participants underwent transthoracic echocardiography. Of these, 1,132 have tricuspid regurgitation (TR) velocity with reliable estimations of peak TR velocity and RVSP. The association between TR velocity and RVSP and common clinical and TTE parameters were assessed using multidimensional network and multivariable-adjusted regression analyses. Analysis included extensive cardiometabolic risk factors, and diastolic and pulmonary function test parameters. We used the Cox proportional hazard model to analyze the relationship between TR velocity and event-free cardiovascular survival. Results: The mean age of the participants was 51 years, with 56.6% female and 62.6% White. Overall, 33.7% had hypertension; 10.8% had diabetes; and 78% had CAC <100. The 97 th quantile TR velocity was 2.6 m/s and the RVSP was 30mmHg ( fig 1 ). While there was a significant increase in TR velocity with age with significant median and upper quantile relationships, the overall nominal change was small. In our study, RVSP was most strongly associated with diastolic parameters (e’ and E/e’) and forced expiratory volume in 1 second (FEV1). In the multivariable-adjusted analysis, age, history of CVD, and e' were independently associated with RVSP after adjustment for traditional risk factors. While TR velocity and RVSP were related to event-free survival on univariable assessment, survival was more closely associated with e’ velocity on multivariable analysis. Conclusion: In the multiracial deeply phenotyped PBHS study, TR velocity thresholds were consistent with ASE guidelines and recent The World Alliance Societies of Echocardiography (WASE) studies. The RVSP was mainly related to diastolic parameters and FEV1.