Cardiology Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, Madrid 28034, Spain.
Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. de Colmenar Viejo km. 9,100, Madrid 28034, Spain.
Eur Heart J Cardiovasc Imaging. 2023 Jul 24;24(8):1092-1101. doi: 10.1093/ehjci/jead052.
The optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown. This study aimed to describe RA function by 2D speckle-tracking echocardiography (STE) in at least severe TR and to evaluate its potential association with cardiovascular outcomes.
Consecutive patients with at least (≥) severe TR (severe, massive, or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent isolated atrial fibrillation (AF) were included for comparison (control and AF group, respectively). RA function was measured with 2D-STE and two components of RA function were calculated: reservoir (RASr) and contractile (RASct) strain (AutoStrain, Philips Medical Systems the EPIQ system). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. Patients with ≥ severe TR (n = 140) showed lower RASr compared with controls (n = 20) and with the AF group (n = 20) (P < 0.001). Atrial TR showed lower RASr compared with other aetiologies of TR (P < 0.001). After a median follow-up of 2.2 years (IQR: 12-41 months), RASr remained an independent predictor of mortality and HF. A cut-off value of RASr of <9.4% held the best accuracy to predict outcomes.
RA function by 2D-STE independently predicts mortality and HF hospitalizations in patients with ≥ severe TR.
严重三尖瓣反流（TR）的最佳治疗仍存在争议。虽然右心室收缩功能是预后的既定标志物，但右心房（RA）功能的潜在作用尚不清楚。本研究旨在通过二维斑点追踪超声心动图（STE）描述至少严重 TR 患者的 RA 功能，并评估其与心血管结局的潜在关联。
连续纳入根据综合临床方案在心脏瓣膜门诊评估的至少（≥）严重 TR（严重、大量或 torrential TR）的患者。连续纳入对照组和永久性孤立性心房颤动（AF）患者作为比较（对照组和 AF 组）。使用二维 STE 测量 RA 功能，并计算 RA 功能的两个成分：储备（RASr）和收缩（RASct）应变（AutoStrain，Philips Medical Systems 的 EPIQ 系统）。定义因心力衰竭（HF）或全因死亡率而住院的联合终点。与对照组（n = 20）和 AF 组（n = 20）相比，≥严重 TR（n = 140）患者的 RASr 较低（P < 0.001）。与其他 TR 病因相比，三尖瓣反流的 RASr 较低（P < 0.001）。中位随访 2.2 年（IQR：12-41 个月）后，RASr 仍然是死亡率和 HF 的独立预测因子。RASr <9.4%的截断值对预测结局具有最佳准确性。
二维 STE 测量的 RA 功能可独立预测严重 TR 患者的死亡率和 HF 住院率。
