Prognostic Value of Right Atrial Strain in Patients With Moderate-to-Severe Tricuspid Regurgitation

Significant tricuspid regurgitation (TR) leads to right ventricular dysfunction and associated comorbidities. As the receiving chamber for regurgitant volume, the right atrium undergoes significant mechanical remodeling. This study investigated whether right atrial reservoir strain (RArS), a key marker of atrial mechanics, serves as a prognostic indicator for mortality in patients with moderate-to-severe TR.

Clinical, laboratory, and echocardiographic data from 289 consecutive patients with TR (grade ≥+3) were analyzed. RArS was evaluated by 2-dimensional speckle-tracking echocardiography using semiautomated software (TOMTEC; Philips). The cohort was divided into 2 groups by RArS above or below the median value.

A total of 239 patients (mean age 82 years, 55% women) were included in the final study. Median RArS was 11.7%. Compared with patients with higher RArS, patients with RArS below median had a higher rate of atrial fibrillation and worse right ventricular function. Lower RArS was also associated with wider inferior vena cava diameter, abnormal cholestatic liver enzymes, and a higher rate of diuretic use. During a median follow-up period of 26 months (interquartile range, 8-31), 99 (41%) patients died. Patients with RArS <11.7% had significantly lower survival rates (52% versus 30%; P<0.001). Multivariable analysis showed that lower RArS was independently associated with higher all-cause mortality (odds ratio, 0.92 [95% CI, 0.85-0.99]; P=0.04).

Impaired RArS assessed by echocardiography is independently associated with all-cause mortality in patients with moderate-severe TR. Serial measurement of RArS can potentially aid in optimizing timing for intervention in patients with TR.