Recommended Criteria to Define Right Ventricular Dysfunction in Severe Secondary Tricuspid Regurgitation: Association With Outcome.

BACKGROUND: The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated. OBJECTIVES: This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort. METHODS: Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention. RESULTS: A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint. CONCLUSIONS: The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.