Right Ventricular Strain in the Prognostic Assessment of Severe Tricuspid Regurgitation and Heart Failure: A Review.

Background: Tricuspid regurgitation (TR) is becoming more commonly recognized as an important contributor to adverse cardiovascular outcomes. Right ventricular (RV) dysfunction influences TR progression and prognosis. RV free wall longitudinal strain (FWLS) is a valuable marker of RV function, though its prognostic significance in TR requires further study.

Methods: We conducted a comprehensive search of studies assessing the role of RV strain in patients with severe TR, heart failure (HF), and those undergoing tricuspid valve interventions, using MEDLINE, EMBASE, and Cochrane databases to identify relevant studies. Retrospective and prospective clinical studies were included, while case reports, case series, and animal studies were excluded.

Results: A decrease in RVFWLS was consistently associated with mortality, HF-related hospitalizations, adverse clinical outcomes in severe TR and in TR valve repair. Several studies have demonstrated that reduced RVFWLS may be an independent predictive factor for poor prognosis, proving to have a superior prognostic value than conventional RV function parameters such as TAPSE and FAC. A number of studies show that assessing RV strain appears critical for optimizing the strategy for percutaneous and surgical treatment of TR. Implementing this parameter in routine echocardiographic evaluation could contribute to more precise timing of interventional treatment, thus improving long-term outcomes and prognosis.

Conclusions: RV strain assessment, particularly RVFWLS, may provide valuable prognostic information in patients with severe TR and help optimize treatment strategies. Implementing RVFWLS into routine echocardiographic evaluation could improve patient selection and timing of interventions.