Tricuspid regurgitation stratification predicts the time course of systemic right ventricle dysfunction among patients on ACE-I/ARB.

Abstract

BackgroundProgressive systemic right ventricle (sRV) dysfunction is a significant challenge in adult congenital heart disease. Current guidelines do not specify effective heart failure medications for patients with sRV, however, previous studies have relied on semi-quantitative assessments. The advancement of cardiac magnetic resonance (CMR) imaging as the gold-standard modality offers quantitatively accurate assessments even for complex cardiac anomalies. Therefore, we aimed to investigate prognostic factors associated with sRV dysfunction in patients on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB), using CMR-derived quantitative values. MethodsWe conducted a retrospective cohort study of seventeen adult sRV patients treated with ACE-I/ARB and performed logistic regression analysis, with the primary outcome defined as sRV ejection fraction (sRVEF) deterioration. ResultsOver an average follow-up period of 68.7 months, sRVEF deterioration occurred in three patients (17%). Logistic regression analysis identified tricuspid regurgitation (TR) as a potential independent prognostic factor for the primary outcome (odds ratio = 1.11; 95% confidence interval, 1.00-1.31). Furthermore, patients with mild TR (TR fraction ≦15%; N=12) experienced improvements in sRVEF between the initial and last CMR assessments (from 49.1±8.4 to 56.7±8.0%, P = 0.0029), with increased stroke volume from 68.2±18.6 to 79.5±17.2 ml (P = 0.0029). In contrast, these changes were not observed in patients with moderate or severe TR (TR fraction >16%) (N=5). ConclusionOur CMR-based evaluation highlights the potential utility of TR stratification in predicting the changes in sRVEF among sRV patients on ACE-I/ARB. Future randomized controlled trials that consider TR severity are required to elucidate the significance of ACE-I/ARB therapy.