Prognostic Value of Tricuspid Annular Tissue Doppler Velocity in Heart Failure with Atrial Fibrillation

Mortality-Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation

BACKGROUND

Tricuspid annular plane systolic excursion (TAPSE) and peak lateral tricuspid annular systolic velocity (S') are echocardiographic indices of right ventricle function. The abnormality thresholds for these parameters are based on data obtained from healthy adults rather than outcome data.

OBJECTIVES

We aimed to reexamine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with or without significant tricuspid regurgitation (TR).

METHODS

We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011 and 2021. Tricuspid regurgitation was assessed using a semiquantitative method. Cutoff values associated with excess mortality were assessed using spline curves in univariate and multivariate Cox analyses.

RESULTS

A total of 24,717 subjects were included in the current analysis. A total of 1,143 (4.6%) subjects had clinically significant (moderate or more) TR. In the entire cohort, TAPSE <20.9 mm and S' <10.9 cm/sec were associated with excess mortality. In subgroup analysis, among subjects with significant TR, TAPSE <18.0 mm and S' <10.0 cm/sec were the cutoffs associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE <21.5 mm and S' <10.9 cm/sec. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE <20.9 mm (hazard ratio = 1.16; 95% CI, 1.10-1.23; P < .001) and S' <10.9 cm/sec (hazard ratio =1.09; 95% CI, 1.04-1.20; P = .01) were independently associated with mortality.

CONCLUSIONS

The TAPSE and S' thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S' cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.

The complex interplay between right ventricular dysfunction and atrial fibrillation - a narrative review

Atrial fibrillation (AF) is one of the most common sustained arrhythmias in clinical practice, associated with multiple comorbidities and complication. The potential predictors of AF onset and perpetuation or specific drivers of complications need future investigation. Right ventricular (RV) dysfunction plays an important role in the development of new-onset AF warranting in-depth analysis in relation to AF. RV may play a significant role in a better characterization of the cardiac substrate of AF patients. The relation between RV dysfunction and AF is bidirectional as AF may be one of the causes of RV dysfunction and their coexistence worsens the overall patient prognosis. Our aim is to present in a narrative review the most relevant data regarding the complex relationship between AF and RV dysfunction.

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.

Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism

BACKGROUND

Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients.

METHODS

One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis.

RESULTS

Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4-80.0; p = 0.02); TAPSE and TV S' showed HR 0.77 (0.67-0.89), p < 0.001, and 0.71 (0.52-0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812-0.932, p = 0.0001, for TV S' was 0.751; 95% CI 0.670-0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83-0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52-0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S' was only of borderline statistical significance.

CONCLUSIONS

It seems that TV S' is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.