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

Aim: We sought to evaluate the differences in prognosis between the atrial (A-STR) and the ventricular (V-STR) phenotypes of secondary tricuspid regurgitation. Materials and methodsConsecutive 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. ResultsA 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 cm(2) vs. 7 +/- 6 cm(2)/m(2), p = 0.007), smaller right ventricular (RV) end-diastolic volumes (72 +/- 27 ml/m(2) vs. 92 +/- 38 ml/m(2); 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/m(2) vs. 55 +/- 23 ml/m(2), 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, CI 95% = 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. ConclusionAlmost 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.