Right Heart Remodeling and Outcomes in Patients With Tricuspid Regurgitation: A Literature Review and Meta-Analysis

Sara Bombace; Federico Fortuni; Giacomo Viggiani; Maria Chiara Meucci; Gianluigi Condorelli; Erberto Carluccio; Maximilian von Roeder; Alexander Jobs; Holger Thiele; Giovanni Esposito; Philipp Lurz; Paul A Grayburn; Anna Sannino

doi:10.1016/j.jcmg.2023.12.011

Right Heart Remodeling and Outcomes in Patients With Tricuspid Regurgitation: A Literature Review and Meta-Analysis

JACC Cardiovasc Imaging. 2024 Feb 12:S1936-878X(24)00032-9. doi: 10.1016/j.jcmg.2023.12.011. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: https://twitter.com/sarabombace.
² Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy. Electronic address: https://twitter.com/FedeFortuni9.
³ Department of Internal Medicine I, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
⁴ Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁵ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy.
⁶ Cardiology and Cardiovascular Pathophysiology, University of Perugia, Perugia, Italy.
⁷ Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.
⁸ Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Science, Leipzig, Germany.
⁹ Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
¹⁰ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
¹¹ Baylor Scott and White Research Institute, Plano, Texas, USA.
¹² Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Baylor Scott and White Research Institute, Plano, Texas, USA; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany. Electronic address: anna.sannino@unina.it.

PMID: 38430099
DOI: 10.1016/j.jcmg.2023.12.011

Abstract

Background: Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR).

Objectives: This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+).

Methods: MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements.

Results: Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, -6.3% [95% CI: -11.1% to -1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, -4.4% [95% CI: -5.9% to -2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, -4.1% [95% CI: -7.6% to -0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, -1.9% [95% CI: -2.5% to -1.3%]; P < 0.001) and mortality.

Conclusions: RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).

Keywords: echocardiography; functional tricuspid regurgitation; right ventricle; survival; tricuspid valve.