AUTHOR=Gavazzoni Mara , Heilbron Francesca , Badano Luigi P. , Radu Noela , Cascella Andrea , Tomaselli Michele , Perelli Francesco , Caravita Sergio , Baratto Claudia , Parati Gianfranco , Muraru Denisa 

TITLE=The atrial secondary tricuspid regurgitation is associated to more favorable outcome than the ventricular phenotype

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1022755

DOI=10.3389/fcvm.2022.1022755

ISSN=2297-055X

ABSTRACT=Aim: We sought to evaluate the differences in prognosis between the atrial (A-STR) and the ventricular (V-STR) phenotypes of secondary tricuspid regurgitation.
Methods. Consecutive patients with moderate or severe STR referred for echocardiography were enrolled. A-STR and V-STR were defined according to the last ACC/AHA guidelines criteria. The primary endpoint was the composite of all-cause death and heart failure (HF) hospitalizations. 
Results. A total of 211 patients were enrolled. The prevalence of A-STR in our cohort was 26%. Patients with A- STR were significantly older and with lower NYHA functional class than V-STR patients. The prevalence of severe STR was similar (28% in A-STR vs 37% in V-STR, p= 0.291). A-STR patients had smaller tenting height (TH) (10±4 mm vs 12±7 mm, p= 0.023), larger end-diastolic tricuspid annulus area (9±2 cm2 vs 7±6 cm2 /m2, p= 0.007), smaller right ventricular (RV) end-diastolic volumes (72±27 ml/m2 vs 92±38 ml/m2; p=0.001) and  better RV longitudinal function (18±7 mm vs 16±6 mm; p=0.126 for TAPSE, and -21±5 % vs -18±5 %; p=0.006, for RV free-wall longitudinal strain, RVFWLS) than V-STR patients.  Conversely, RV ejection fraction (RVEF, 48 ± 10% vs 46 ± 11%, p= 0.257) and maximal right atrial volumes (64 ± 38 ml/m2 vs 55 ± 23ml/m2, p=0.327) were similar between the two groups. 
After a median follow-up of 10 months, patients with V-STR had a 2.7-fold higher risk (HR: 2.7, 95%CI 95%=1.3-5.7) of experiencing the combined endpoint than A-STR patients. The factors related to outcomes resulted different between the two STR phenotypes: TR-severity (HR: 5.8, CI95%=1,4–25, P= 0.019) in A-STR patients; TR severity (HR 2.9, 95%CI 1.4-6.3, p=0.005), RVEF (HR: 0.97, 95%CI 0.94-0.99, p=0.044), and RVFWLS (HR: 0.93, 95%CI 0.85-0.98, p=0.009) in V-STR. 
Conclusion: Almost one-third of patients referred to the echocardiography laboratory for significant STR have A-STR. A-STR patients had a lower incidence of the combined endpoint than V-STR patients. Moreover, while TR severity was the only independent factor associated to outcome in A-STR patients, TR severity and RV function were independently associated with outcome in V-STR patients.