Abstract
Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure Results A total of 70 patients were included (mean age was 74±8 years, 71% females). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes. Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001 Conclusion In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.
Published Version
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