Diuretic dose and right atrial function interplay in patients with tricuspid regurgitation

Tricuspid regurgitation is frequent, and its related systemic venous congestion is associated with mortality. Diuretics are the main therapy but what shapes their effect is not fully known.

In this single-center cross-sectional study, we aimed to assess the association of right heart metrics of size and function in relation to diuretic dose. In consecutive patients with measurable tricuspid regurgitation regurgitant volume (RVol) by echocardiography, a high diuretic dose (HDD) was considered a furosemide dose (or equivalent) of greater than 40 mg. Parameters of right atrial (RA) and right ventricular (RV) size and function, tricuspid regurgitation degree and congestion signs were compared between groups with or without HDD.

Of 120 patients (37% men; age 74 ± 13 years), 31.7% had HDD. HDD was prevalent in 16% of patients with mild tricuspid regurgitation, 25% with moderate tricuspid regurgitation and 49% with severe tricuspid regurgitation ( P  = 0.011). In multivariate analysis including RV and RA parameters of size and function, only the RA strain was independently associated with diuretic therapy ( B -0.111, P  < 0.0001) and HDD ( B -0.101, P  = 0.007). There was a progressive decline in RA strain with increasing diuretic dose ( PANOVA  < 0.0001). The RA strain was lower in HDD patients independently of chronic kidney disease ( P for interaction 0.798) and tricuspid regurgitation severity ( P for interaction 0.712). Most patients with congestive signs showed a lower RA strain (all P  < 0.05).

Reduced RA function in tricuspid regurgitation patients with venous congestion is independently associated with a higher dose of diuretic therapy.