Reduced Right Ventricular Strain in the Presence of Normal TAPSE and FAC is Associated with Reduced Survival in Functional Tricuspid Regurgitation

Background:

Volume overload associated with functional tricuspid regurgitation (FTR) confounds the interpretation of TAPSE and FAC as index of RV function. Reduced RV strain unmasks myocardial dysfunction in the presence of normal TAPSE and FAC. We examined the effect of reduced RV strain on survival of patients with FTR.

Methods:

This is an on-going retrospective study of over 900 patients. In the 302 patients with severe FTR (115 males, mean age 72±14 years) we measured RV strain with a normal cutoff value of 24%, TAPSE with cutoff of 1.6cm, and RV FAC with cutoff of 35%. Patients were categorized into three sub-groups: NNN = normal FAC, TAPSE and RV strain, LLL = all three abnormal, and NNL = abnormal RV strain only. The Kaplan-Meier method was used for survival analysis.

Results:

The Kaplan-Meier analysis (Figure 1) showed that the survival probability was lowest in the LLL group (60% and 51% @1 and 4 years). Those in the NNL group also had significantly reduced survival @1 and 4 years (76% and 65%) when compared to those in NNN (82% and 68% @1 and 4 years, respectively, p < 0.05).

Conclusion:

In this cohort of patients with FTR the survival probability is significantly reduced in patients with abnormal RV strain. Based on this data, the timing for intervention in FTR maybe best predicted by abnormal RV strain even in the presence of normal TAPSE and FAC.