Key result
TVARC and ASE cutoffs for RV dysfunction predict higher mortality and HF hospitalization.
Why the study?
TVARC and ASE proposed echocardiographic cutoffs to define right ventricular dysfunction in secondary tricuspid regurgitation, but these thresholds have not yet been validated.
Do the TVARC and ASE echocardiography cutoffs for right ventricular dysfunction predict mortality and heart failure hospitalization in patients with severe secondary tricuspid regurgitation?
Cohort (n=1,550)
Do the TVARC and ASE echocardiography cutoffs for right ventricular dysfunction predict mortality and heart failure hospitalization in patients with severe secondary tricuspid regurgitation?
The proposed TVARC and ASE echocardiographic cutoffs for right ventricular dysfunction, particularly combining TAPSE and RVFWLS, provide significant prognostic value for risk stratification in patients with severe secondary tricuspid regurgitation.
May aid prognostication in severe secondary TR; extends validation of TVARC/ASE cutoffs but remains hypothesis-generating.
BACKGROUND: The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated. OBJECTIVES: This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort. METHODS: Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention. RESULTS: A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint. CONCLUSIONS: The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
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Galloo et al. (2026) conducted a cohort in Secondary tricuspid regurgitation (n=1,550). TVARC and ASE echocardiography cutoffs for right ventricular dysfunction was evaluated on Composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention (p=<0.001 and <0.005). The TVARC and ASE echocardiography cutoffs for right ventricular dysfunction were independently associated with mortality and heart failure hospitalization (P<0.001 and P<0.005, respectively).
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