Association of Effective Regurgitant Orifice Area to Tricuspid Annular Plane Systolic Excursion Ratio with Outcomes After Tricuspid Annuloplasty

Abstract

Background : Assessment of secondary tricuspid regurgitation (TR) severity does not correct for right heart function. We hypothesized that TR severity may be proportional or disproportional to the degree of right ventricular dysfunction and investigated its prognostic implications in patients undergoing tricuspid annuloplasty. Methods : The ratios of pre-procedural effective regurgitant ori fi ce area (EROA) with tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 290 patients undergoing tricuspid annuloplasty. The optimal threshold of EROA/TAPSE ratio associated with increased risk for adverse events was derived from maximally selected rank statistics. Results : The cutoff value of EROA/TAPSE ratio associated with an excess risk of adverse events was 3.42, and 104 (36%) had EROA/TAPSE ratios > 3.42. Compared to those with EROA/TAPSE ratios ≤ 3.42, patients with EROA/TAPSE ratios > 3.42 had a higher prevalence of moderate-to-severe aortic stenosis, a lower prevalence of moderate-to-severe mitral regurgitation, larger right heart dimensions, and more exaggerated tricuspid lea fl et displacement. Over a 4.1-year median follow-up, 79 adverse events (47 heart failure hospitalizations and 32 deaths) occurred. Patients with EROA/TAPSE ratios > 3.42 had higher rates of adverse events than those with EROA/TAPSE ratios ≤ 3.42 (44% vs 18%; P < 0.001) and were independently associated with poor outcomes on multivariate analysis. TR proportionality provided incremental prognostic value to both the EuroSCORE II and STS score (incremental c 2 ¼ 23.510 and 20.616 respectively; P < 0.05). Conclusions : EROA/TAPSE ratio > 3.42 is independently associated with adverse prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV function may improve patient selection and risk strati fi - cation for tricuspid annuloplasty.