RESUMO
AIMS: Depending on volume status, secondary tricuspid regurgitation (sTR) has a strong dynamic component. In contrast, associated structural dilatation of the tricuspid annulus and the right heart chambers may be less volume dependent. This study aimed to assess the prognostic value of right heart remodeling in isolated severe sTR (isoTR). METHODS AND RESULTS: A total of 36,000 patients from the longitudinal echocardiographic database of our tertiary center were screened for severe isoTR [vena contracta (VC)≥7mm] in the absence of atrial fibrillation (AF), other valve disease, and/or reduced systolic left ventricular function. Echocardiographic examinations were reread, focusing on right ventricular (RV) parameters and on quantitative and qualitative parameters of isoTR. All-cause mortality was defined the primary endpoint.216 patients fulfilled the inclusion criteria. Severe TR was predominant, only few were classified in the new grades massive [n=23(10%)] and torrential TR [n=4(2%)]. During a median follow-up of 35 months (20-53), all-cause mortality was 31%(n=67). Multivariate Cox regression analysis revealed no association of VC, EROA, or regurgitant volume with all-cause mortality. However, indexed RV end-diastolic diameter (p<0.001), indexed right atrial dimensions (p=0.019), and particularly tricuspid valve (TV) annulus diameter diastole index (TADI:p=0.002) and TV annulus diameter systole index (TASI:p=0.001) were significantly associated with outcome. CONCLUSION: Severe isolated TR in absence of AF is a rare finding with grim prognosis. Tricuspid annular diameter dimensions rather than quantitative measures of TR proved to be of significant prognostic value indicating a continuous remodeling leading to a "point of no return" with dismal outcome.
