Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation

Bannehr, Marwin; Kahn, Ulrike; Liebchen, Josephin; Okamoto, Maki; Hähnel, Valentin; Georgi, Christian; Dworok, Victoria; Edlinger, Christoph; Lichtenauer, Michael; Kücken, Tanja; Kropf, Siegfried; Haase-Fielitz, Anja; Butter, Christian

doi:10.1016/j.cjca.2021.01.006

Cited by 29 publications

(12 citation statements)

References 35 publications

(44 reference statements)

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“…Numerous studies have shown that reduced RVF is associated with worse prognosis in severe TR [ 15 , 16 ]. However, it still remains unclear if the same lower limits of normality apply for each of the parameters as in patients without TR.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Schneider

König

Geller

et al. 2021

JCM

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Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Schneider

König

Geller

et al. 2021

JCM

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“…Similar study from Germany reported that mortality in patients with TR increased with increasing of TR level, but they also found that reduced TAPSE (<18.5 mm), decreased FAC (<35%), and impaired free-wall RV longitudinal strain (>-18%) were predictors of mortality in the observed population of 1089 patients with TR [35]. However, reduced free-wall RV longitudinal strain was superior predictor of mortality in comparison with reduced FAC (<35%) and TAPSE in the whole population [36]. Ancona et al involved only patients with severe TR who were mostly presented with symptoms of RV heart failure and advanced NYHA class [6].…”

Section: Right Ventricular Remodeling and Its Predictive Importance In Ftrmentioning

confidence: 92%

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

et al. 2021

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Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.

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“…67,68 Right ventricular function is an important stage-defining feature of almost all patients with VHD; it strongly affects survival and the risk of intervention. 69 Reduced right ventricular free wall longitudinal strain (see Fig. 2) may be a red flag for postoperative right ventricular afterload mismatch 70 and worse outcomes in patients with apparently normal preoperative fractional area change and tricuspid anulus excursion.…”

Section: Heart Valve Diseasesmentioning

confidence: 99%

“…Right ventricular function is an important stage-defining feature of almost all patients with VHD; it strongly affects survival and the risk of intervention 69 . Reduced right ventricular free wall longitudinal strain (see Fig.…”

Section: Heart Valve Diseasesmentioning

confidence: 99%

Speckle tracking echocardiography in early disease stages: a therapy modifier?

Mandoli

Cameli

Pastore

et al. 2023

Journal of Cardiovascular Medicine

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Echocardiography has been included as a first-line tool in several international guidelines for the management of patients with various cardiac diseases. Beyond diagnosis, echocardiographic examination helps in characterizing the severity of the condition since the very first stages. In particular, the application of second-level techniques, speckle tracking echocardiography in particular, can also reveal a subclinical dysfunction, while the standard parameters are in the normality range. The present review describes the potentialities of advanced echocardiography in different settings, including arterial hypertension, atrial fibrillation, diastolic dysfunction, and oncological patients, thus opening up potential starting points for its application as a clinical routine changer.

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Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation

Abstract: See editorial by Hassanin et al., pages 945e948 of this issue.

Cited by 29 publications

References 35 publications

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

Speckle tracking echocardiography in early disease stages: a therapy modifier?

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