Tricuspid regurgitation peak velocity reflects structural and diastolic severity but not survival in cardiac amyloidosis
M El Blidi, V Quentin, S Badini-Kontogom, C Statescu, F Besson, E Berthelot, F BauerAbstract
Background
Cardiac amyloidosis is frequently associated with right-sided involvement and elevated pulmonary pressures. Tricuspid regurgitation peak velocity (TR Vmax), an echocardiographic surrogate of pulmonary hypertension, may reflect advanced myocardial infiltration and ventricular interaction. Its relationship with left ventricular phenotype and prognosis in cardiac amyloidosis remains incompletely defined.
Methods
We conducted a retrospective observational study including patients with cardiac amyloidosis who underwent comprehensive transthoracic echocardiography at diagnosis. Patients were stratified according to TR Vmax into three predefined groups: <2.8 m/s, 2.8–3.4 m/s, and >3.4 m/s. Left ventricular ejection fraction (LVEF), wall thickness, E/e′ ratio, and left atrial (LA) volume were compared across groups. Overall survival was assessed using Kaplan–Meier analysis and compared using the log-rank test.
Results
Among 165 patients with available TR Vmax and follow-up data, 95 had TR Vmax <2.8 m/s, 61 had values between 2.8 and 3.4 m/s, and 9 had TR Vmax >3.4 m/s. Women were underrepresented overall, with a lower proportion in higher TR Vmax strata (p < 0.05). LVEF was preserved and comparable across the three groups (mean ≈54%, p = NS). In contrast, increasing TR Vmax was associated with greater left ventricular wall thickness (p < 0.05), indicating more advanced myocardial infiltration. Diastolic dysfunction worsened with increasing TR Vmax, with significantly higher E/e′ ratios across strata (p < 0.01). Left atrial volume increased progressively with TR Vmax severity, reflecting elevated chronic filling pressures (p < 0.01). Kaplan–Meier survival analysis did not demonstrate a statistically significant difference in overall survival between TR Vmax groups (log-rank χ² = 0.48, p = 0.79, figure), although patients with higher TR Vmax showed a numerical trend toward reduced survival.
Conclusion
In cardiac amyloidosis, elevated TR Vmax is associated with a more advanced structural and diastolic phenotype, characterized by increased wall thickness, higher E/e′ ratio, and larger left atrial volume, while systolic function remains preserved. However, TR Vmax stratification alone did not identify significant differences in survival. These findings suggest that TR Vmax reflects disease severity but has limited standalone prognostic value and should be interpreted within a comprehensive multiparametric echocardiographic assessment.Kaplan-Meier Survival CurvesFor image description, please refer to the figure legend and surrounding text.