Recommended Criteria to Define Right Ventricular Dysfunction in Severe Secondary Tricuspid Regurgitation
Abstract
BACKGROUND: The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated. OBJECTIVES: This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort. METHODS: Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention. RESULTS: A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint. CONCLUSIONS: The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
Authors 9
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Xavier Galloo Aachen
Leiden University · Vrije Universiteit Brussel · Leiden University Medical Center · Universitair Ziekenhuis Brussel
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium. Electronic address: https://twitter.com/XGalloo
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Edgard Prihadi Aachen
Leiden University · Leiden University Medical Center · ZNA Middelheim Hospital
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands; Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Federico Fortuni Aachen
Leiden University · University of Perugia · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands; Cardiology and Cardiovascular Pathophysiology, S. Maria della Miscericordia Hospital, University of Perugia, Perugia, Italy
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Inserm · Laboratoire Traitement du Signal et de l'Image · Centre Hospitalier Universitaire de Rennes
Affiliation as printed
Department of Cardiology, Centre Hospitalier Universitaire Rennes, Inserm, Laboratoire Traitement du Signal et de l-Image-Unité Mixte de Recherche 1099, Universitaire Rennes 1, Rennes, France. Electronic address: https://twitter.com/DonalErwan
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NewYork–Presbyterian Hospital · Columbia University Irving Medical Center
Affiliation as printed
Department of Medicine Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA. Electronic address: https://twitter.com/hahn_rt
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Jeroen Joost Bax Aachen
Leiden University · University of Turku · Leiden University Medical Center · Turku University Hospital
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands; Heart Centre, University of Turku and Turku University Hospital, Turku, Finland
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: n.ajmone@lumc.nl
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