Prevalence, morphologic characterization, and prognosis of atrial, ventricular, and overlap functional tricuspid regurgitation phenotypes
C Jantsch, S Koschatko, M Autherith, L Hauptmann, K Halavina, C Torrefranca, M Koschutnik, C Demirel, V Dannenberg, C Hengstenberg, N Pavo, C Nitsche, P Bartko, G HeitzingerAbstract
Background
Functional tricuspid regurgitation (fTR) is associated with symptomatic burden, heart failure (HF) hospitalizations, and increased mortality. Although atrial and ventricular fTR phenotypes have been identified, with important prognostic implications, their characterization is often not entirely possible due to overlapping features.
Objectives
We aimed to investigate the prevalence, morphological characteristics, and outcomes of atrial (AfTR), ventricular (VfTR), and fTR with overlapping features (OfTR).
Methods
This retrospective study encompasses patients diagnosed with fTR from 2010 to 2020. Patients with severe fTR were characterized as AfTR, VfTR according to available recommendations.
Results
AfTR was present in 144 (11.8%), VfTR in 450 (36.9%), and OfTR in 625 (51.3%) patients. OfTR patients were older and had more atrial fibrillation. This phenotype was characterized by a disproportionate right atrial (RA) to right ventricular (RV) ratio with severe RA dilatation, but preserved RV area. OfTR patients had reduced longitudinal but preserved radial RV function. FTR severity, as indicated by orifice area, was similar between the phenotypes. After eight years, the highest mortality was observed for OfTR (48%), followed by VfTR (38%) and AfTR (33%) (p<0.001). OfTR was associated with worse survival (HR 2.55 [2.26-2.88], p<0.001), even after adjustment.
Conclusion
Distinct phenotypes of fTR present with differential features and outcomes. OfTR is the most prevalent fTR phenotype, associated with the highest mortality, and its hazard increases with increasing fTR severity. Further research is necessary to determine the role of these findings in optimizing fTR treatment.Figure 1Figure 2