In patients with severe tricuspid regurgitation, impaired right ventricular free wall strain at rest (<-22.0%) was associated with lower 3-year cardiac event-free survival (47% vs 85%, p<0.001).
Cohort (n=124)
Does right ventricular free wall strain during exercise stress echocardiography predict cardiac events in patients with severe tricuspid regurgitation?
In patients with severe tricuspid regurgitation, right ventricular free wall strain at rest and during exercise stress echocardiography is a strong predictor of cardiac death and heart failure hospitalization.
Hazard Ratio: 1.13 (95% CI 1.06–1.2)
Absolute Event Rate: 47% vs 85%
p-value: p=<0.001
Abstract Backgrounds The poor prognosis of patients with severe tricuspid regurgitation (TR) has been reported. However, there are few reports on the relationship between echocardiographic parameters during exercise and cardiac events. Objective We aimed to identify the incidence rates of cardiac events and their associated factors in patients with severe TR who underwent exercise stress echocardiography (ESE). Methods We registered 124 consecutive patients with severe TR who underwent ESE. The causes of TR were divided into secondary TR due to atrial fibrillation, secondary TR associated with pulmonary hypertension due to left ventricular or left atrial dysfunction, and primary TR. Backgrounds and echocardiographic parameters during exercise were investigated. The outcome of cardiac events was a composite of cardiac death and hospitalization for heart failure. Results Cardiac events occurred in 42 patients (34%) during a median follow-up period of years. Between patients with (n=42) and without (n=84) cardiac events, no differences were shown in age, sex, the etiology, haemodynamics before and after ESE (blood pressure, cardiac output, and TR pressure gradient), and LV function, including ejection fraction and LV global longitudinal strain. Conversely, the indices of right ventricle (RV) function before and after exercise, including TAPSE, S’, FAC, and RV free wall strain (RVFWS), % peak VO2, and VE/VCO2 slope were worse in patients with cardiac events than those without cardiac events. Among those indices of RV function, RVFWS at rest and peak workload showed the best predictive ability of cardiac events (Rest: AUC 0.71, cut-off value -22.0%: Sensitivity 70%, Specificity 63%, HR 1.13 per 1% worsening: 95% CI 1.06–1.20, p0.001、peak: AUC 0.67, cut-off value -17.4%: Sensitivity 42%, Specificity 85%, HR 1.10 per 1% worsening: 95% CI 1.04–1.17, p=0.001). In the Kaplan-Meier analysis, cardiac event-free survival at 3 years after ESE was poor in patients with impaired RVFWS than those with preserved RVFWS, both at rest (-22.0%: 47% vs. 85%, p0.001) and peak workload (-17.4%: 44% vs. 77%, p0.004). RVFWS at peak workload was correlated with % peak VO2 (r=0.30, p=0.006). Conclusions In patients with severe TR, cardiac-related prognosis depended not on its etiology, background, and LV function but on RV function. RVFWS was the best index of RV function for stratifying the cardiac-related prognosis and showed a significant correlation with O2 consumption. Figure 2
Amano et al. (Thu,) conducted a cohort in Severe tricuspid regurgitation (n=124). Impaired right ventricular free wall strain (RVFWS) vs. Preserved RVFWS was evaluated on Cardiac event-free survival (composite of cardiac death and hospitalization for heart failure) (HR 1.13, 95% CI 1.06-1.20, p=<0.001). In patients with severe tricuspid regurgitation, impaired right ventricular free wall strain at rest (<-22.0%) was associated with lower 3-year cardiac event-free survival (47% vs 85%, p<0.001).