Effect Of Tricuspid Regurgitation On Decongestion And Right Atrial Pressure Changes In Patients With Decompensated Heart Failure

Abstract

<h3>Background</h3> Tricuspid Regurgitation (TR) is a common risk factor for acute decompensated heart failure (ADHF). However, less is known about the impact of TR on the response of non-invasive indices of decongestion such as weight loss/fluid loss, and right atrial pressure (RAP) to diuretic therapy. We examined these associations in patients hospitalized with ADHF. <h3>Methods</h3> We studied 54 consecutive advanced HF patients admitted for ADHF, who underwent two right heart catheterizations during their hospitalization. These patients also had two-dimensional echocardiographic (TTE) assessments performed during the same hospitalization. <h3>Results</h3> Most patients were African American (65%), men (77%) with a mean age of 58 years. Twenty-one (39%) patients had at least moderate and severe TR (mod-sev TR) vs 33 (61%) had no to mild TR (no-mild TR). Compared to patients with mod-sev TR, those with no-mild TR had similar mean weight loss (3.7 ± 7.7 vs. 3.7 ± 7.6 kg, <i>p</i>=0.35) and similar mean fluid loss of (7.8 ± 8.7 vs. 8 ± 9 liters, <i>p</i>=0.62). The 2 groups had similar mean RAP at baseline (no-mild TR 15 ± 7.8 mm Hg; mod-sev TR 16 ± 5.9 mm Hg; <i>p=</i>0.59). They also had similar changes in mean RAP after diuresis (-5.8 ± 8.9 mm Hg vs. -6.6 ± 6.9 mm Hg, <i>p</i>=0.72). There was modest correlation noted between net fluid loss and weight loss in no-mild TR group (<i>r=</i>0.44; <i>p=</i>0.01) whereas no correlation was noted between net fluid loss and weight loss in mod-sev group (<i>r=</i>0.86; <i>p</i>=0.99). There was also no correlation between change in weight and change in RAP (no-mild TR <i>r=</i>0.12; <i>p=</i>0.51; mod-sev TR <i>r=</i>0.11; <i>p=</i>0.68) or change in fluid balance and change in RAP (no-mild TR <i>r=</i>0.01; <i>p</i>=0.95; mod-sev TR <i>r=</i>0.35; <i>p</i>=0.94) in either group. <h3>Conclusion</h3> In patients with advanced heart failure admitted with acute decompensation, there is no effect of TR on decongestion or changes in RAP as conventional noninvasive methods to assess decongestion such as change in weight and in fluid balance, poorly reflect changes in RAP in patients with no-mild TR and those with mod-sev TR. This warrants a need to identify novel non-invasive markers of decongestion in patients admitted with acute decompensated heart failure.