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Tricuspid Regurgitation Stratification Predicts the Time Course of Systemic Right Ventricle Dysfunction Among
Kohsaku Goto1, Katsura Soma1, Hiroyuki Tokiwa1,2
1Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
CJC Pediatric and Congenital Heart Disease
|December 2, 2024
Summary
Tricuspid regurgitation severity predicts right ventricle function changes in adults with congenital heart disease on ACE-I/ARB therapy. Mild TR improves right ventricle ejection fraction, while moderate/severe TR does not show these benefits.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Cardiac Imaging
Background:
- Systemic right ventricle (sRV) dysfunction is a major concern in adult congenital heart disease.
- Current heart failure medication guidelines lack specific recommendations for sRV patients.
- Cardiac magnetic resonance (CMR) provides quantitative assessments crucial for complex cardiac anomalies.
Purpose of the Study:
- To identify prognostic factors for sRV dysfunction in patients treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB).
- To utilize CMR-derived quantitative values for assessing sRV function and its predictors.
Main Methods:
- Retrospective cohort study of 17 adult patients with sRV on ACE-I/ARB.
- Logistic regression analysis to determine factors associated with sRV ejection fraction (sRVEF) deterioration.
- Primary outcome: sRVEF deterioration over an average follow-up of 68.7 months.
Main Results:
- sRVEF deterioration occurred in 17% of patients over the follow-up period.
- Tricuspid regurgitation (TR) was identified as a potential independent prognostic factor (OR = 1.11).
- Patients with mild TR (≤15%) showed significant improvements in sRVEF and stroke volume, unlike those with moderate/severe TR (>16%).
Conclusions:
- CMR-based evaluation and TR stratification can predict sRVEF changes in sRV patients on ACE-I/ARB.
- Further randomized controlled trials incorporating TR severity are needed to clarify the role of ACE-I/ARB therapy.
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