TY - JOUR
T1 - Right ventricular systolic function in severe tricuspid regurgitation
T2 - Prognostic relevance of longitudinal strain
AU - Ancona, Francesco
AU - Melillo, Francesco
AU - Calvo, Francesco
AU - Attalla El Halabieh, Nadia
AU - Stella, Stefano
AU - Capogrosso, Cristina
AU - Ingallina, Giacomo
AU - Tafciu, Elvin
AU - Pascaretta, Antonia
AU - Ancona, Marco Bruno
AU - De Bonis, Michele
AU - Castiglioni, Alessandro
AU - Denti, Paolo
AU - Montorfano, Matteo
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Alfieri, Ottavio
AU - Agricola, Eustachio
N1 - Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Aims: The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results: We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42-56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion: Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.
AB - Aims: The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results: We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42-56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion: Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.
KW - right ventricular free wall longitudinal strain
KW - right ventricular systolic function
KW - strain analysis
KW - tricuspid regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85110142843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110142843&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jeab030
DO - 10.1093/ehjci/jeab030
M3 - Article
C2 - 33623973
AN - SCOPUS:85110142843
SN - 2047-2404
VL - 22
SP - 868
EP - 875
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 8
ER -