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Valvular heart disease
Original research
Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation
  1. Xavier Galloo1,2,
  2. Federico Fortuni1,3,
  3. Maria Chiara Meucci1,4,
  4. Steele C Butcher1,5,
  5. Marlieke F Dietz1,
  6. Edgard A Prihadi1,6,
  7. Bernard Cosyns2,
  8. Victoria Delgado1,7,
  9. Jeroen J Bax1,8,
  10. Nina Ajmone Marsan1
  1. 1 Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
  2. 2 Department of Cardiology, UZ Brussel, Brussel, Belgium
  3. 3 Department of Cardiology, Ospedale Nuovo San Giovanni Battista, Foligno, Umbria, Italy
  4. 4 Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  5. 5 Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
  6. 6 Department of Cardiology, Ziekenhuisnetwerk Antwerpen, Antwerpen, Belgium
  7. 7 Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
  8. 8 Heart Center, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
  1. Correspondence to Dr Nina Ajmone Marsan, Department of Cardiology, Leiden University Medical Center, Leiden 2330RC, Zuid-Holland, Netherlands; n.ajmone{at}lumc.nl

Abstract

Objective Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis.

Methods Consecutive patients, from a single centre, with first diagnosis of severe STR and RASr measure available, were included. Extensive echocardiographic analysis comprised measures of cardiac chamber size and function, assessed also by two-dimensional speckle-tracking strain analysis. Primary outcome was all-cause mortality, analysed from inclusion until death or last follow-up. The association of RASr with the outcome was evaluated by Cox regression analysis and Akaike information criterion.

Results A total of 586 patients with severe STR (age 68±13 years; 52% male) were included. Patients presented with mild right ventricular (RV) dilatation (end-diastolic area 13.8±6.5 cm2/m2) and dysfunction (free-wall strain 16.2±7.2%), and with moderate-to-severe RA dilatation (max area 15.0±5.3 cm2/m2); the median value of RASr was 13%. In the overall population, 10-year overall survival was low (40%, 349 deaths), and was significantly lower in patients with lower RASr (defined by the median value): 36% (195 deaths) for RASr ≤13% compared with 45% (154 deaths) for RASr >13% (log-rank p=0.016). With a median follow-up of 6.6 years, RASr was independently associated with all-cause mortality (HR per 5% RASr increase:0.928; 95% CI 0.864 to 0.996; p=0.038), providing additional value over relevant clinical and echocardiographic covariates (including RA size and RV function/size).

Conclusions Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients.

  • Tricuspid Valve Insufficiency
  • Heart Valve Diseases
  • Echocardiography
  • Outcome Assessment, Health Care

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2023-323084

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @XGalloo

    • Contributors XG: Conception or design of the work; acquisition, analysis, and interpretation of data for the work; drafting the work; final approval of the version to be published; XG is responsible for the overall content as the guarantor and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FF: Conception or design of the work; acquisition, analysis, and interpretation of data for the work; revising the article critically for important intellectual content; final approval of the version to be published. MCM: Conception or design of the work; acquisition, analysis, and interpretation of data for the work; revising the article critically for important intellectual content; final approval of the version to be published. SCB: Conception or design of the work; acquisition, analysis, and interpretation of data for the work; revising the article critically for important intellectual content; final approval of the version to be published. MFD: Conception or design of the work; acquisition of data for the work; revising the article critically for important intellectual content; final approval of the version to be published. EAP: Conception or design of the work; acquisition of data for the work; revising the article critically for important intellectual content; final approval of the version to be published. BC: Conception or design of the work; revising the article critically for important intellectual content; final approval of the version to be published. VD: Conception or design of the work; revising the article critically for important intellectual content; final approval of the version to be published. JJB: Conception or design of the work; revising the article critically for important intellectual content; final approval of the version to be published. NAM: Conception or design of the work; analysis, and interpretation of data for the work; drafting the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was funded by an unrestricted research grant from Edwards Lifesciences (IISUSTHV2018017).

    • Competing interests The Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre has received unrestricted research grants from Abbott Vascular, Alnylam, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic, Medis, Pie Medical, Pfizer, and Novartis. VD received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, Medtronic, MSD and Novartis. JJB received speaker fees from Abbott Vascular, Edwards Lifesciences and Omron. NAM received speaker fees from Abbott Vascular, Philips Ultrasound and GE Healthcare. The remaining authors have nothing to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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