Determinants of outcome in atrial functional tricuspid regurgitation

Q: What are the key findings of this study?

Reservoir right atrial strain was independently associated with all-cause mortality in patients with atrial functional tricuspid regurgitation (adjusted HR 0.88 per 1%-point change, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial functional tricuspid regurgitation (n=152). Intervention: Reservoir right atrial (RA) strain vs. Continuous measure (per 1%-point change). Primary outcome: All-cause mortality (HR 0.88, 95% CI 0.81-0.95, p=<0.001).

Q: What does this research mean for the field?

In patients with atrial functional tricuspid regurgitation, lower reservoir right atrial strain is independently associated with an increased risk of all-cause mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jawza Aldakhil; Kush Patel; Sveeta Badiani; Steffen E. Petersen; Guy Lloyd; Sanjeev Bhattacharyya

doi:10.1186/s44156-026-00140-4

October 18, 2026Echo Research and PracticeOpen Access

Determinants of outcome in atrial functional tricuspid regurgitation

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Key result

Higher reservoir RA strain linked to ~12% lower mortality per percentage point in atrial functional TR.

HR 0.88
95% CI 0.81-0.95
P<0.001
n=152

Why the study?

Prognostic predictors in patients with atrial functional tricuspid regurgitation due to atrial remodelling in atrial fibrillation remain incompletely defined.

Does reduced right atrial reservoir strain predict all-cause mortality in patients with atrial functional tricuspid regurgitation?

Study Design

Type

Cohort (n=152)

Multicenter

No

Structured PICO

Does reduced right atrial reservoir strain predict all-cause mortality in patients with atrial functional tricuspid regurgitation?

P

Population

152 patients with atrial fibrillation, comprising 120 with atrial functional tricuspid regurgitation and 32 controls, followed for a median of 6.3 years.

E

Exposure

Echocardiographic assessment of right atrial (RA) reservoir strain and the presence of atrial functional tricuspid regurgitation (AFTR).

C

Comparator

32 control patients with atrial fibrillation but mild/trivial/no mitral or tricuspid regurgitation irrespective of right atrial size.

O

Outcome

All-cause mortality, defined as death from any cause during follow-up.hard clinical

Main Result

Hazard Ratio: 0.88 (95% CI 0.81–0.95)

p-value: p=<0.001

Limitations

Retrospective single-centre study subject to selection bias
Strain analysis was performed using a single vendor-specific platform
Beat-selection method was not recorded for each study
Residual confounding by baseline heart-failure severity cannot be excluded
Only all-cause mortality data were available, without cause-specific mortality or heart failure hospitalisations
Modest sample size for the survival analysis

Implication

In patients with atrial fibrillation, reduced right atrial reservoir strain is independently associated with increased all-cause mortality, highlighting its value as a prognostic marker for risk stratifying patients with atrial functional tricuspid regurgitation.

Abstract

Background Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a result of atrial remodelling in patients with atrial fibrillation (AF). However, prognostic predictors in this population remain incompletely defined. Objectives To evaluate echocardiographic characteristics and identify predictors of all-cause mortality in patients with AFTR. Methods We retrospectively studied consecutive patients with AF who underwent transthoracic echocardiography between 2017 and 2025. Inclusion required significant right atrial remodelling, defined as a right atrial area > 25 cm 2 . Patients with at least moderate functional tricuspid regurgitation comprised the AFTR cohort, while patients with mild/trivial/no tricuspid regurgitation served as controls. Patients with primary valvular disease, cardiomyopathy, congenital heart disease, device-related valve disease, RV dilatation, or more than mild RV systolic dysfunction were excluded. Cox proportional hazards regression was performed to identify predictors of mortality. Results A total of 152 patients were included, comprising 120 patients with AFTR and 32 controls. Compared with controls, patients with AFTR demonstrated larger atrial dimensions, higher right-sided hemodynamic-burden, impaired RV longitudinal strain, and reduced reservoir RA strain. During a median follow-up of 6.3 years, 53 deaths (45%) occurred among patients with AFTR. In univariable Cox analysis, age (HR 1.02, 95% CI 1.00-1.04; p = 0.016), TR Vmax (HR 1.59, 95% CI 1.07–2.35; p = 0.020), and lower reservoir RA strain (HR 0.90, 95% CI 0.84–0.96; p = 0.003) were associated with mortality. In multivariable analysis, reservoir RA strain remained independently associated with mortality (adjusted HR 0.88, 95% CI 0.81–0.95; p < 0.001). Conclusion AFTR is characterized by marked biatrial remodelling and impaired right atrial function. Reduced RA reservoir strain was independently associated with mortality, supporting a potential role for RA deformation imaging in risk stratification in AFTR.

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Cite This Study

Aldakhil et al. (2026) conducted a cohort in Atrial functional tricuspid regurgitation (n=152). Reservoir right atrial (RA) strain vs. Continuous measure (per 1%-point change) was evaluated on All-cause mortality (HR 0.88, 95% CI 0.81-0.95, p=<0.001). Reservoir right atrial strain was independently associated with all-cause mortality in patients with atrial functional tricuspid regurgitation (adjusted HR 0.88 per 1%-point change, p<0.001).

synapsesocial.com/papers/6ad5f0d5ceb5f40a576e8846 https://doi.org/10.1186/s44156-026-00140-4