Association of longitudinal left atrial strain with mortality after tricuspid valve surgery

Abstract

Aims Tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR) is becoming more common, but the associated mortality remains high. Therefore, we evaluated the clinical and echocardiographic parameters associated with all‐cause mortality in patients with severe functional TR who underwent TV surgery. Methods and results A total of 286 patients with severe functional TR who underwent TV replacement or repair was analysed between January 2006 and December 2017. We assessed changes in conventional echocardiographic parameters and strain, such as peak atrial longitudinal strain (PALS). During a median follow‐up period of 5.3 years, 71 (24.8%) patients died due to any cause. When comparing groups with and without all‐cause deaths, there were no significant differences in terms of sex, co‐morbidities, medication use, and surgery type. However, patients who died were older and more likely to have refractory atrial fibrillation (AF). With multivariate Cox modelling, age >65 years (adjusted hazard ratio [HR], 2.81, 95% confidence interval [CI], 1.59–4.96; P < 0.001), refractory AF (adjusted HR, 2.84, 95% CI, 1.36–5.94; P = 0.006), lower albumin level (adjusted HR, 0.50, 95% CI, 0.31–0.82), and reduced PALS (adjusted HR, 1.87, 95% CI, 1.06–3.33; P = 0.032) were significant determinants of all‐cause mortality. PALS decline was associated with refractory AF (adjusted HR, 5.74, 95% CI, 2.81–11.7; P < 0.001) and the absence of a Maze procedure (adjusted HR, 2.95, 95% CI, 1.51–5.78; P = 0.002). Conclusions A reduction in PALS was significantly associated with all‐cause mortality in our cohort of patients with severe functional TR who underwent TV surgery. This phenomenon is related to refractory AF and more aggressive intervention for AF is necessary concomitant with TV surgery.

2023 Korean Society of Echocardiography position paper for the diagnosis and management of valvular heart disease, part II: mitral and tricuspid valve disease

“…In a total of 213 patients with moderate or severe TR, a cutoff value of 40 mm for tricuspid annulus was the best predictor for cardiovascular events [ 147 ]. In patients with severe isolated TR undergoing TV surgery, reduced RV global longitudinal strain [ 148 ], reduced peak atrial longitudinal strain [ 149 ], and preoperative RV free-wall longitudinal strain were associated with poor clinical outcomes [ 150 ]. In atrial functional TR, baseline RA enlargement, and RA area to RV end-systolic area ratio were strong risk factors for progression of atrial functional TR [ 151 ].…”

Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease

“…A larger cohort study included 289 patients with severe functional TR who underwent surgical TV replacement or repair and showed that reduced LAS-r was significantly associated with all-cause mortality in 24.8% of them during a median follow-up period of 5.3 years. [ 81 ] In addition, the recurrence rate of TR is high even after successful surgery (15%–20% within the first year, 30%–70% within 3–5 years) and is associated with a poor prognosis. [ 82 ] Reduced LAS-r <5.9% was identified as an independent predictor of recurrent TR with sensitivity 75.6% and specificity 61.1% in patients with rheumatic MS and functional TR who underwent MV replacement and concomitant TV repair.…”