Background: Data regarding the right ventricular (RV) mechanical adaptation to secondary tricuspid regurgitation (STR) is scarce.
Objectives: We investigated the changes in RV contraction pattern in patients with different STR severity and etiology, and their association with outcomes.
Methods: We enrolled 205 patients with STR (60% female, age: 77±12 years), in a single-center prospective observational study. We used three-dimensional echocardiography to measure RV ejection fraction (RVEF), the absolute contribution of the RV longitudinal (LEF), radial (REF), and anteroposterior (AEF) ejection fraction components, and their relative contribution by indexing to global RVEF (LEF/RVEF; REF/RVEF; AEF/RVEF). The patients were followed for a median of 9 months. The primary outcome was defined as heart failure hospitalization or all-cause death.
Results: Patients with different STR severity did not differ in terms of RVEF (mild vs. moderate vs. severe, RVEF: 50±11 vs. 49±9 vs. 50±10%, respectively, p=0.085). However, LEF/RVEF was significantly lower in severe STR (0.39±0.08 vs. 0.39±0.09 vs. 0.35±0.10, respectively, p=0.049). Patients with ventricular STR had lower global RVEF (48±10% vs. 53±8%, p=0.001), LEF (18±6% vs. 20±5 %, p=0.043), REF (23±9% vs. 28±8%, p=0.002), and REF/RVEF (0.48±0.012 vs. 0.52±0.09; p=0.040) than patients with atrial STR. In a multivariable Cox regression model, REF/RVEF was a significant and independent predictor of outcomes in the entire cohort (hazard ratio, 0.980 [CI, 0.961-1.000] per 0.01 unit change, p=0.047), while global RVEF was not.
Conclusions: Patients with STR demonstrate significant functional RV remodelling. Patients with severe STR show a significant decrease in the RV longitudinal shortening. Apart from STR severity, STR etiology also influences the RV contraction pattern, which was associated with outcomes in our cohort.
Aims: Cardiac surgery is the cornerstone of treatment of several heart conditions, but accurate risk stratification is critical. Commonly used scores do not include right ventricular (RV) function. We aimed to evaluate whether three-dimensional (3D) RV ejection fraction (RVEF) predicts outcomes in patients undergoing cardiac surgery after adjusting for the EuroSCORE II.
Methods and results: This is a prospective multicenter study of adult patients undergoing cardiac surgery at 3 centers. Right ventricular function parameters were analyzed with transesophageal echocardiogram before the surgery. We evaluated the association of 3D RVEF with the primary outcome (composite of in-hospital mortality or need of temporary ventricular assist device) after adjusting for the EuroSCORE II. Exploratory end points were time on mechanical ventilation and time on inotropes. We included 248 patients (median age, 69 years; 43% female). Sixty-nine percent had normal RVEF (≥45%). Right ventricular function parameters (tricuspid annular plane systolic excursion, fractional area change, and RV free-wall longitudinal strain) were lower in the group of decreased RVEF (P < .001 for all). The primary outcome occurred in 28 patients (11%). After adjusting for the EuroSCORE II, decreased RVEF was independently associated with the primary outcome (hazard ratio = 2.46; 95% CI, 1.10, 5.50; P = .028). Importantly, 3D RVEF was superior to all other parameters of RV systolic function to predict the primary outcome (P = .006). At 30 days, survival free of the primary end point was 72% ± 8% versus 93% ± 3% (P < .001) in decreased versus normal RVEF, respectively. Right ventricular ejection fraction was associated with shorter time on mechanical ventilation (r = -0.27, P < .001) and shorter time on inotropes (r = -0.20, P = .01).
Conclusions: Among the RV function parameters, 3D RVEF is the strongest predictor of in-hospital mortality or need of temporary ventricular assist device in patients undergoing cardiac surgery. This multicenter study suggests that 3D RVEF should be included in the evaluation of patients undergoing surgery because it might improve stratification.