Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation

• Published in: Heart (British Cardiac Society) Vol. 110; no. 6; p. 448
• Main Authors: Galloo, Xavier, Fortuni, Federico, Meucci, Maria Chiara, Butcher, Steele C, Dietz, Marlieke F, Prihadi, Edgard A, Cosyns, Bernard, Delgado, Victoria, Bax, Jeroen J, Ajmone Marsan, Nina
• Format: Journal Article
• Language: English
• Published: England 01-03-2024
• Subjects: Aged; Aged, 80 and over; Echocardiography; Female; Heart Atria - diagnostic imaging; Heart Failure; Humans; Male; Middle Aged; Prognosis; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - etiology; Ventricular Dysfunction, Right; Ventricular Function, Right; Heart Valve Diseases; Echocardiography; Tricuspid Valve Insufficiency; Outcome Assessment, Health Care
• ISSN: 1468-201X
• DOI: 10.1136/heartjnl-2023-323084

Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis.
Consecutive patients, from a single centre, with first diagnosis of severe STR and RASr measure available, were included. Extensive echocardiographic analysis comprised measures of cardiac chamber size and function, assessed also by two-dimensional speckle-tracking strain analysis. Primary outcome was all-cause mortality, analysed from inclusion until death or last follow-up. The association of RASr with the outcome was evaluated by Cox regression analysis and Akaike information criterion.
A total of 586 patients with severe STR (age 68±13 years; 52% male) were included. Patients presented with mild right ventricular (RV) dilatation (end-diastolic area 13.8±6.5 cm
/m
) and dysfunction (free-wall strain 16.2±7.2%), and with moderate-to-severe RA dilatation (max area 15.0±5.3 cm
/m
); the median value of RASr was 13%. In the overall population, 10-year overall survival was low (40%, 349 deaths), and was significantly lower in patients with lower RASr (defined by the median value): 36% (195 deaths) for RASr ≤13% compared with 45% (154 deaths) for RASr >13% (log-rank p=0.016). With a median follow-up of 6.6 years, RASr was independently associated with all-cause mortality (HR per 5% RASr increase:0.928; 95% CI 0.864 to 0.996; p=0.038), providing additional value over relevant clinical and echocardiographic covariates (including RA size and RV function/size).
Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients.