Abstract
BackgroundFunctional tricuspid regurgitation (TR) is common among patients with left heart disease and may recur during the follow-up period after selective tricuspid valve annuloplasty (TVA). This study aims to analyse the relationship between left atrial (LA) strain and the degree of preoperative functional TR and to explore the role of LA strain in predicting TR recurrence.MethodsThis study included 63 patients with rheumatic mitral stenosis who underwent mitral valve replacement and concomitant TVA. Additionally, 20 healthy controls were enrolled. Preoperative conventional LA echocardiographic parameters and LA strain were measured. The association between LA strain and preoperative functional TR severity was analysed by Pearson correlation. Predictors of recurrent TR were determined by multivariate logistic regression analyses.ResultsCompared with the control group, the mitral stenosis group developed a significant impairment in terms of LA strain. The degree of preoperative functional TR exhibited moderate correlations with LA reservoir strain (r = − 0.57) and LA conduit strain (r = 0.48). During a median follow-up period of 66.4 ± 36.4 months, TR recurred in 18 patients. Preoperative LA reservoir strain and the mean transmitral gradient were predictors of postoperative TR recurrence. When the two indexes were combined to establish a prediction, the sensitivity and specificity of prediction increased. The area under the receiver operating characteristic curve of the combined indicator was higher than those of the single indicators (0.90 vs. 0.70 and 0.72).ConclusionsLA strain correlates with preoperative functional TR severity in patients with rheumatic mitral stenosis. The LA reservoir strain and preoperative mean transmitral gradient are independent predictive factors for recurrent TR after TVA.
Highlights
Functional tricuspid regurgitation (TR) is quite common in left heart disease, and several studies have confirmed that preoperative functional TR may progress if left untreated at the time of left-sided valve surgery
According to the receiver operating characteristic (ROC) curve analysis, the sensitivities and specificities for predicting recurrent TR were 75.6 and 61.1% for left atrial (LA) reservoir strain < 5.9% (AUC: 0.70, 95% Confidence interval (CI) 0.59–0.85) and 55.6 and 83.7% for mean transmitral gradient > 12.5 mmHg (AUC: 0.72, 95% CI 0.57– 0.87), respectively
Preoperative functional TR severity was correlated with LA strain in rheumatic mitral stenosis patients; this is the first study to provide clear evidence of this association
Summary
Functional tricuspid regurgitation (TR) is quite common in left heart disease, and several studies have confirmed that preoperative functional TR may progress if left untreated at the time of left-sided valve surgery. Kim et al confirmed that the maintenance and recovery of LA mechanical function are valuable for preventing progression of functional TR in patients undergoing left-sided valve surgery [3]. These studies were mainly concerned with the effects of conventional echocardiographic parameters on functional TR, which have limited value in reflecting LA function. Functional tricuspid regurgitation (TR) is common among patients with left heart disease and may recur during the follow-up period after selective tricuspid valve annuloplasty (TVA). This study aims to analyse the relationship between left atrial (LA) strain and the degree of preoperative functional TR and to explore the role of LA strain in predicting TR recurrence
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