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

Authors

Yi-Kei Tse, Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
Hang-Long Li, Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
Calvin Ka-Lam Leung, Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Si-Yeung Yu, Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
Jia-Yi Huang, Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
Qing-Wen Ren, Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Mei-Zhen Wu, Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Hung-Fat Tse, Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Kai-Hang Yiu, Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, ChinaFollow

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 orifice 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 leaflet 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%; P3.42 is independently associated with adverse prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV function may improve patient selection and risk stratification for tricuspid annuloplasty.

Recommended Citation

Yi-Kei Tse, Hang-Long Li, Calvin Ka-Lam Leung, Si-Yeung Yu, Jia-Yi Huang, Qing-Wen Ren, Mei-Zhen Wu, Hung-Fat Tse, Kai-Hang Yiu, Association of Effective Regurgitant Orifice Area to Tricuspid Annular Plane Systolic Excursion Ratio with Outcomes After Tricuspid Annuloplasty Journal of the Hong Kong College of Cardiology 2023;30(4) https://doi.org/10.55503/2790-6744.1511

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