Patients with atrial secondary tricuspid regurgitation in sinus rhythm had a 10-year survival rate of 69%, significantly worse than the 81% in matched controls (p=0.029).
Does significant atrial secondary tricuspid regurgitation without atrial fibrillation worsen the composite of all-cause mortality and heart failure hospitalization compared to matched controls?
Patients with atrial secondary tricuspid regurgitation in sinus rhythm have worse LV diastolic function and significantly worse long-term outcomes compared to matched controls without structural heart disease.
Tasa de eventos absoluta: 0% vs 0%
Abstract Introduction Atrial secondary tricuspid regurgitation (A-STR), a distinct subtype of secondary TR evolving with predominant right atrial (RA) remodelling, has been mainly associated with long-standing atrial fibrillation (AF). However, A-STR has been reported also in the absence of documented AF, but the characteristics and outcome of these patients remain poorly understood. Purpose To evaluate clinical and echocardiographic characteristics of patients with A-STR without concomitant AF as compared to matched controls. Methods In this multicentre study, 113 patients with significant (≥moderate) A-STR without a history of AF were matched 1:1 to 113 controls without structural heart disease based on age, sex, and comorbidities, such as diabetes and arterial hypertension. The study endpoint was a composite of all-cause mortality and heart failure hospitalization. Patients undergoing tricuspid valve intervention were censored at the time of the intervention. Results A total of 226 patients were included (age 68±12years, 66% female). By study design, baseline demographics and comorbidities were similar between the A-STR and control groups.However, A-STR patients had significantly higher NYHA functional class (NYHA II-IV: A-STR :48% vs. control: 9%,p0.001. Fig1). As expected, increased TA diameter (A-STR:40mm vs. control: 23mm, p0.001), right ventricular (RV) dimensions, and right atrial volumes (A-STR:44mL/m2 vs. control:13mL/m2, p0.001) were observed in the A-STR group. In addition, these patients showed lower RV fractional area change (A-STR :47% vs. control: 44%, p = 0.019) and a trend towards reduced TAPSE and RV free wall strain. Of note, RA reservoir strain was not significantly different between groups (Fig1). Interestingly, significant differences in left ventricular (LV) remodelling were observed, with higher LV mass and impaired LV global longitudinal strain (A-STR: 17% vs. control: 19%, p=0.002) in the A-STR group. Also, larger left atrial (LA) volume index (A-STR: 34 mL/m2 vs. control: 26 mL/m2, p0.001) and impaired LA reservoir strain (A-STR: 23% vs. control: 29%, p0.001) contributed to a higher degree of LV diastolic dysfunction (grade 1: A-STR: 50% vs. control: 3%, p0.001) for the A-STR group as compared to the control group. During median follow-up of 49 (6-117) months, 35 (10%) patients reached the study endpoint. Kaplan-Meier survival analyses demonstrated significantly worse outcomes in the A-STR group compared to controls (p log-rank = 0.029, also after adjusting for other important variables), with a 10-year survival rate of 69% in the A-STR group versus 81% in the control group (Fig 2). Conclusion Patients with A-STR in sinus rhythm without evidence of AF showed higher NYHA class, worse LV diastolic function and worse outcomes compared to matched controls. These findings highlight the importance of close follow-up of patients with LV diastolic dysfunction at risk for A-STR worsening and their timely management.Baseline characteristics. Event-free survival curve.
Sarrazyn et al. (Thu,) reported a other. Patients with atrial secondary tricuspid regurgitation in sinus rhythm had a 10-year survival rate of 69%, significantly worse than the 81% in matched controls (p=0.029).