Right Atrial Remodeling and Outcome in Patients with Secondary Tricuspid Regurgitation - 02/05/24
, Francesco P. Perelli, MD a, c, Francesca Heilbron, MD a, Andrea Cascella, MD a, c, Mara Gavazzoni, MD a, Diana R. Hădăreanu, MD, PhD d, Sorina Mihaila, MD, PhD e, f, Giorgio Oliverio, MD a, Marco Penso, BME a, Sergio Caravita, MD, PhD a, g, Claudia Baratto, MD, PhD a, Samantha Fisicaro, RDCS a, Gianfranco Parati, MD a, c, Denisa Muraru, MD, PhD a, cAbstract |
Background |
In patients with secondary tricuspid regurgitation (STR), right atrial remodeling (RAR) is a proven marker of disease progression. However, the prognostic value of RAR, assessed by indexed right atrial volume (RAVi) and reservoir strain (RAS), remains to be clarified. Accordingly, the aim of our study is to investigate the association with outcome of RAR in patients with STR.
Methods |
We enrolled 397 patients (44% men, 72.7 ± 13 years old) with mild to severe STR. Complete two-dimensional and speckle-tracking echocardiography analysis of right atrial and right ventricular (RV) size and function were obtained in all patients. The primary end point was the composite of death from any cause and heart failure hospitalization.
Results |
After a median follow-up of 15 months (interquartile range, 6-23), the end point was reached by 158 patients (39%). Patients with RAS <13% and RAVi >48 mL/m2 had significantly lower survival rates compared to patients with RAS ≥13% and RAVi 
48 mL/m2 (log-rank P < .001). On multivariable analysis, RAS <13% (hazard ratio, 2.11; 95% CI, 1.43-3.11; P < .001) and RAVi > 48 mL/m2 (hazard ratio, 1.49; 95% CI, 1.01-2.18; P = .04) remained associated with the combined end point, even after adjusting for RV free-wall longitudinal strain, significant chronic kidney disease, and New York Heart Association class. Secondary tricuspid regurgitation excess mortality increased exponentially with values of 18.2% and 51.3 mL/m2 for RAS and RAVi, respectively. In nested models, the addition of RAS and RAVi provided incremental prognostic value over clinical, conventional echocardiographic parameters of RV size and function and RV free-wall longitudinal strain.
Conclusions |
In patients with STR, RAR was independently associated with mortality and heart failure hospitalization. Assessment of RAR could improve risk stratification of patients with STR, potentially identifying those who may benefit from optimization of medical therapy and a closer follow-up.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Impact of RAR on the association with outcome in 397 cases of STR. Bar graph representing the nested regression models for the composite end point of death and hospitalization for HF. Model 0 consisted of multivariate basal model including more than moderate MR and STR, NYHA class, and moderate to severe CKD. Model 1 consisted of the addition of RV function (RV FWLS, TAPSE, and RV FAC) and PASP to model 0. Model 2 consisted of the addition of RAR (RAS <13% and RAVi>48 mL/m2) to model 1. The bars show the χ2 values of the resulting models at each level. FWS, Free wall strain; PASP, pulmonary artery systolic pressure.
Central IllustrationImpact of RAR on the association with outcome in 397 cases of STR. Bar graph representing the nested regression models for the composite end point of death and hospitalization for HF. Model 0 consisted of multivariate basal model including more than moderate MR and STR, NYHA class, and moderate to severe CKD. Model 1 consisted of the addition of RV function (RV FWLS, TAPSE, and RV FAC) and PASP to model 0. Model 2 consisted of the addition of RAR (RAS <13% and RAVi>48 mL/m2) to model 1. The bars show the χ2 values of the resulting models at each level. FWS, Free wall strain; PASP, pulmonary artery systolic pressure.Le texte complet de cet article est disponible en PDF.
Highlights |
• | The potential prognostic role of RA volume and deformation in patients with STR is still in question. |
• | RAR provides prognostic value in patients with STR. |
• | Echocardiographic assessment of RAR could improve the risk stratification of patients with STR. |
Keywords : Secondary tricuspid regurgitation, Speckle-tracking echocardiography, Right atrial volume, Right atrial remodeling, Right atrial strain
Abbreviations : 2D, AF, AUC, CKD, EROA, FAC, FWLS, HF, HR, ICC, LV, LVEF, MR, NYHA, PASP, RA, RAR, RAS, RAVi, RegVol, ROC, RV, STE, STR, TAPSE, TR, TV
Plan
| Drs. Tomaselli and Radu contributed equally to this work. |
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| This work was supported by Italian Ministry of Health - Ricerca Finalizzata RF-2021-12374122. |
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| Sorin V. Pislaru, MD, PhD, served as guest editor for this report. |
Vol 37 - N° 5
P. 495-505 - mai 2024 Retour au numéro
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