Key result
Impaired right ventricular longitudinal strain independently predicted 2-year all-cause mortality in patients with functional tricuspid regurgitation (HR 1.130; 95% CI 1.099-1.160; P<0.001).
Why the study?
Although right ventricular dysfunction is known to affect outcomes in functional tricuspid regurgitation, it remains unknown which echocardiographic parameters most accurately reflect prognosis.
Does echocardiographic assessment of right ventricular strain and TAPSE improve prediction of 2-year mortality compared to tricuspid regurgitation grade alone in patients with functional tricuspid regurgitation?
Observational (n=1,089)
Does echocardiographic assessment of right ventricular strain and TAPSE improve prediction of 2-year mortality compared to tricuspid regurgitation grade alone in patients with functional tricuspid regurgitation?
Hazard Ratio: 1.13 (95% CI 1.099–1.16)
p-value: p=<0.001
Echocardiographic assessment of right ventricular longitudinal strain provides significant incremental prognostic value for 2-year mortality beyond tricuspid regurgitation grading alone.
RV strain may refine mortality prediction in functional TR; leaves open whether it should guide decisions pending prospective validation.
BACKGROUND: Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR. METHODS: Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed. RESULTS: Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001). CONCLUSIONS: Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.
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Bannehr et al. (2021) conducted an observational in Functional tricuspid regurgitation (n=1,089). Impaired right ventricular longitudinal strain vs. Normal right ventricular longitudinal strain was evaluated on 2-year all-cause mortality (HR 1.130, 95% CI 1.099-1.160, p=<0.001). Impaired right ventricular longitudinal strain independently predicted 2-year all-cause mortality in patients with functional tricuspid regurgitation (HR 1.130; 95% CI 1.099-1.160; P<0.001).
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