Key result
Higher right atrial reservoir strain is linked to lower all-cause mortality in tricuspid regurgitation.
Why the study?
Significant tricuspid regurgitation leads to mechanical remodeling of the right atrium, but whether right atrial reservoir strain serves as a prognostic indicator for mortality in moderate-to-severe disease was unclear.
Does impaired right atrial reservoir strain predict higher all-cause mortality in patients with moderate-to-severe tricuspid regurgitation?
Cohort (n=239)
No
Does impaired right atrial reservoir strain predict higher all-cause mortality in patients with moderate-to-severe tricuspid regurgitation?
Odds Ratio: 0.92 (95% CI 0.85–0.99)
Absolute Event Rate: 52% vs 30%
p-value: p=0.04
Impaired right atrial reservoir strain is an independent predictor of all-cause mortality in patients with moderate-to-severe tricuspid regurgitation and offers prognostic value independent of pulmonary hypertension severity or traditional right ventricular metrics.
May aid risk stratification in moderate-to-severe TR; leaves open prospective validation before clinical adoption.
Background Significant tricuspid regurgitation (TR) leads to right ventricular dysfunction and associated comorbidities. As the receiving chamber for regurgitant volume, the right atrium undergoes significant mechanical remodeling. This study investigated whether right atrial reservoir strain (RArS), a key marker of atrial mechanics, serves as a prognostic indicator for mortality in patients with moderate‐to‐severe TR. Methods Clinical, laboratory, and echocardiographic data from 289 consecutive patients with TR (grade ≥+3) were analyzed. RArS was evaluated by 2‐dimensional speckle‐tracking echocardiography using semiautomated software (TOMTEC; Philips). The cohort was divided into 2 groups by RArS above or below the median value. Results A total of 239 patients (mean age 82 years, 55% women) were included in the final study. Median RArS was 11.7%. Compared with patients with higher RArS, patients with RArS below median had a higher rate of atrial fibrillation and worse right ventricular function. Lower RArS was also associated with wider inferior vena cava diameter, abnormal cholestatic liver enzymes, and a higher rate of diuretic use. During a median follow‐up period of 26 months (interquartile range, 8–31), 99 (41%) patients died. Patients with RArS <11.7% had significantly lower survival rates (52% versus 30%; P <0.001). Multivariable analysis showed that lower RArS was independently associated with higher all‐cause mortality (odds ratio, 0.92 [95% CI, 0.85–0.99]; P =0.04). Conclusions Impaired RArS assessed by echocardiography is independently associated with all‐cause mortality in patients with moderate–severe TR. Serial measurement of RArS can potentially aid in optimizing timing for intervention in patients with TR.
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Merin et al. (2026) conducted a cohort in Moderate-to-severe tricuspid regurgitation (n=239). Impaired right atrial reservoir strain (RArS <11.7%) vs. Preserved right atrial reservoir strain (RArS ≥11.7%) was evaluated on All-cause mortality (OR 0.92, 95% CI 0.85-0.99, p=0.04). In moderate-to-severe tricuspid regurgitation, right atrial reservoir strain below 11.7% was associated with higher all-cause mortality (52% vs 30%; OR 0.92 per 1% increase, p=0.04).
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