Abstract 14268: Prognostic Value of Clinical and Echocardiographic Factors in Atrial Functional Tricuspid Regurgitation

Abstract

Introduction: Atrial functional tricuspid regurgitation (AFTR) is an increasingly recognized and prevalent clinical entity associated with adverse outcomes. Hypothesis: We evaluated the clinical and echocardiographic features of AFTR and those associated with poor prognosis. Methods: Consecutive patients with at least moderate-to-severe and isolated AFTR during 14 years were studied, and clinical and echocardiographic parameters including that for TR and the right heart were analyzed. Multivariable and receiver-operative characteristics analyses were performed to identify predictors and their thresholds for all-cause mortality during follow-up. Results: Amongst 155 AFTR patients (age 73±15, female 83%), 58(37%) were symptomatic, and 80 (52%) had atrial fibrillation. There were 77 (49%) deaths over a mean follow-up of 3.9±3.3 years. Multivariable analyses results are shown in the Table 1, were symptoms, right atrial strain and right ventricular systolic pressure (RVSP) were independently associated with mortality during follow-up with hazards ratios (95% confidence intervals, P-values) of 3.27 (1.18-9.04, P=0.022), 0.95 per 1% increase (0.92-0.98, P=0.01), and 1.05 per 1 mmHg increase (1.01-1.09, P=0.003). Area under curve (95% confidence interval) and optimal thresholds for the most important echocardiographic parameters to predict mortality were RVSP 0.80 (0.74-0.92) >44 mmHg, right atrial strain 0.73 (0.62-0.84) < +21%, and right ventricular free wall longitudinal strain 0.69 (0.57-0.81) > -18%. Conclusions: Significant AFTR is associated with adverse prognosis, therefore accurate diagnosis is critical. The key predictors of mortality include symptoms, reduced right atrial strain and higher RVSP, and their presence may prompt more aggressive medical and procedural therapies in AFTR patients that warrants further research.