Left atrial enlargement and MV annulus diameter predict significant post-pericardiectomy TR, which doubles all-cause mortality risk (HR 2.26, p=0.018).
Does the development of moderate or greater tricuspid regurgitation after pericardiectomy increase all-cause mortality in patients with constrictive pericarditis?
The development of moderate or greater tricuspid regurgitation after pericardiectomy for constrictive pericarditis is associated with a more than two-fold increased risk of all-cause mortality, with preoperative left atrial enlargement serving as a key predictor.
Absolute Event Rate: 0% vs 0%
Abstract Background Constrictive pericarditis (CP) is a chronic inflammatory disorder characterized by pericardial fibrosis and thickening, leading to diastolic filling impairment and restrictive ventricular expansion. After pericardiectomy, postoperative tricuspid regurgitation (TR) progression is one of the complications and can be associated with poor clinical outcomes. Objectives This study aims to identify echocardiographic and clinical predictors as well as clinical significance of TR development following pericardiectomy in patients with CP. Methods This study included 207 consecutive adult patients aged 18 years or older diagnosed with CP, who underwent pericardiectomy between March 1991 and March 2023. After excluding patients with confounding factors, a total of 132 patients with mild or less TR before pericardiectomy were enrolled for this study analysis, and they were divided into two groups based on TR severity observed in pre-discharge echocardiography; Patients who maintained mild or less TR were classified into the No-TR group, while those who showed moderate or greater TR were classified into the TR group. The primary endpoint was defined as all-cause death. Results Among 132 patients, 110 patients (83.3%) were classified into the No-TR group, while 22 patients (16.7%) were into TR group. The median follow-up period was 4.65 years. In the preoperative echocardiography, the mitral valve (MV) annulus diameter during late diastole was significantly longer (31.9 ± 3.4 vs. 29.9 ± 3.1 mm, p = 0.008) and the left atrial volume index (LAVI) was larger (48.8 ± 20.2 vs. 35.1 ± 16.8 mL/m², p = 0.001) in the TR group than in the No-TR group. Univariable analysis also identified those two parameters as predictors of significant TR after pericardiectomy. The optimal cutoff value for MV annulus diameter, and LAVI were 30.51 mm and 29.78 mL/m², respectively. In the postoperative echocardiography, higher mitral E velocity, TR velocity, and right ventricular systolic pressure were observed in the TR group compared with No-TR group. All-cause mortality was significantly higher in the TR group than in the No-TR group (HR 2.26, 95% CI 1.09–4.70, log-rank p = 0.018). Conclusion Left atrial enlargement is a risk factor of significant TR development after pericardiectomy, probably through high left atrial and pulmonary artery pressure. This result may provide a clue in selecting patients who may benefit from concomitant TV annuloplasty.
Lim et al. (Sat,) reported a other. Left atrial enlargement and MV annulus diameter predict significant post-pericardiectomy TR, which doubles all-cause mortality risk (HR 2.26, p=0.018).