Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation
Por:
Galloo, X, Fortuni, F, Meucci, MC, Butcher, SC, Dietz, MF, Prihadi, EA, Cosyns, B, Delgado, V, Bax, JJ and Marsan, NA
Publicada:
1 mar 2024
Ahead of Print:
1 oct 2023
Resumen:
Objective Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis.Methods Consecutive patients, from a single centre, with first diagnosis of severe STR and RASr measure available, were included. Extensive echocardiographic analysis comprised measures of cardiac chamber size and function, assessed also by two-dimensional speckle-tracking strain analysis. Primary outcome was all-cause mortality, analysed from inclusion until death or last follow-up. The association of RASr with the outcome was evaluated by Cox regression analysis and Akaike information criterion.Results A total of 586 patients with severe STR (age 68 +/- 13 years; 52% male) were included. Patients presented with mild right ventricular (RV) dilatation (end-diastolic area 13.8 +/- 6.5 cm(2)/m(2)) and dysfunction (free-wall strain 16.2 +/- 7.2%), and with moderate-to-severe RA dilatation (max area 15.0 +/- 5.3 cm(2)/m(2)); the median value of RASr was 13%. In the overall population, 10-year overall survival was low (40%, 349 deaths), and was significantly lower in patients with lower RASr (defined by the median value): 36% (195 deaths) for RASr <= 13% compared with 45% (154 deaths) for RASr >13% (log-rank p=0.016). With a median follow-up of 6.6 years, RASr was independently associated with all-cause mortality (HR per 5% RASr increase:0.928; 95% CI 0.864 to 0.996; p=0.038), providing additional value over relevant clinical and echocardiographic covariates (including RA size and RV function/size).Conclusions Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients.
Filiaciones:
Galloo, X:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
UZ Brussel, Dept Cardiol, Brussels, Belgium
Fortuni, F:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Osped Nuovo San Giovanni Battista, Dept Cardiol, Foligno, Umbria, Italy
Meucci, MC:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Fdn Policlin Univ Agostino Gemelli IRCCS, Dept Cardiovasc Med, Rome, Italy
Butcher, SC:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Royal Perth Hosp, Dept Cardiol, Perth, WA, Australia
Dietz, MF:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Prihadi, EA:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Ziekenhuisnetwerk Antwerpen, Dept Cardiol, Antwerp, Belgium
Cosyns, B:
UZ Brussel, Dept Cardiol, Brussels, Belgium
:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Univ Hosp Germans Trias & Pujol, Dept Cardiol, Badalona, Catalunya, Spain
Bax, JJ:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
TYKS Turku Univ Hosp, Heart Ctr, Turku, Varsinais Suomi, Finland
Marsan, NA:
Leiden Univ Med Ctr, Dept Cardiol, NL-2330 RC Leiden, Netherlands
Green Published
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