Right ventricular longitudinal strain predicts survival in patients with functional tricuspid regurgitation.

BACKGROUND: Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts the outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. This study aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR.

METHODS: Data from 1,089 consecutive patients were analyzed. 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 two-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: 13.9 % patients showed no, 61.2 % mild, 213 19.6 % moderate and 5.3 % severe TR. TR grade was associated with increased mortality (Log rank, p < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (HR 1.130, 95 % CI 1.099 - 1.160, p < 0.001; HR 1.131, 95 % CI 1.085 - 1.175, p < 0.001). Both, RV strain and TAPSE improved the reference model for survival prediction (IDI 0.184, 95 % CI 0.146 - 0.221, p < 0.001; IDI 0.057, 95 % CI 0.037 - 0.077, p < 0.001).

CONCLUSION: In patients with TR, echocardiographic evaluation of RV function appears of interest. Assessment of RV strain provides additional value for two-year mortality.