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. 2023 May 31;24(6):733-741.
doi: 10.1093/ehjci/jead016.

Prognostic implications of atrial vs. ventricular functional tricuspid regurgitation

Xavier Galloo  1   2 , Marlieke F Dietz  1 , Federico Fortuni  1   3 , Edgard A Prihadi  1   4 , Bernard Cosyns  2 , Victoria Delgado  1   5 , Jeroen J Bax  1   6 , Nina Ajmone Marsan  1
Affiliations

Prognostic implications of atrial vs. ventricular functional tricuspid regurgitation

Xavier Galloo et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Atrial functional tricuspid regurgitation (AFTR) has shown distinctive pathophysiological and anatomical differences compared with ventricular functional tricuspid regurgitation (VFTR) with potential implications for interventions. However, little is known about the difference in long-term prognosis between these two FTR-aetiologies, which was investigated in the current study.

Methods and results: Patients with severe FTR were divided into two aetiologies, based on echocardiography: AFTR and VFTR. VFTR was further subdivided into (i) left-sided cardiac disease; (ii) pulmonary hypertension; and (iii) right ventricular dysfunction. Long-term mortality rates were compared and independent associates of all-cause mortality were investigated.A total of 1037 patients with severe FTR were included, of which 129 patients (23%) were classified as AFTR and compared with 425 patients (78%) classified as VFTR and in sinus rhythm. Of the 425 VFTR patients, 340 patients (61%) had left-sided cardiac disease, 37 patients (7%) had pulmonary hypertension, and 48 patients (9%) had right ventricular dysfunction. Cumulative 10-year survival rates were significantly better for patients with AFTR (78%) compared with VFTR (46%, log-rank P < 0.001). On multivariable Cox regression analysis, VFTR as well as all VFTR subtypes were independently associated with worse overall survival compared with AFTR (HR: 2.292, P < 0.001 for VFTR).

Conclusion: Patients with AFTR had significantly better survival as compared with patients with VFTR, as well as all VFTR subtypes, independently of other clinical and echocardiographic characteristics.

Keywords: atrial functional tricuspid regurgitation; functional tricuspid regurgitation; survival; tricuspid valve; ventricular functional tricuspid regurgitation.

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Conflict of interest statement

Conflict of interest: The Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre has received unrestricted research grants from Abbott Vascular, Alnylam, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic, and Novartis. V.D. received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, Medtronic, MSD and Novartis. J.J.B. received speaker fees from Abbott Vascular and Edwards Lifesciences. N.A.M. received speaker fees from Abbott Vascular, Philips Ultrasound and GE Healthcare. The remaining authors have nothing to disclose.

Figures

Graphical Abstract
Graphical Abstract
Distribution of severe FTR and overall survival according to the FTR-aetiology. AFTR, atrial functional tricuspid regurgitation; FTR, functional tricuspid regurgitation; RV, right ventricle; TR, tricuspid regurgitation; VFTR, ventricular functional tricuspid regurgitation.
Figure 1
Figure 1
Flowchart for study population selection. FTR, functional tricuspid regurgitation; LHD, left-sided heart disease; LVD, left-sided valvular disease; TR, tricuspid regurgitation.
Figure 2
Figure 2
Kaplan–Meier curves for overall survival according to atrial and ventricular FTR. FTR, functional tricuspid regurgitation.
Figure 3
Figure 3
Kaplan–Meier curves for overall survival according to FTR-aetiologies. FTR, functional tricuspid regurgitation.
See this image and copyright information in PMC

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