Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Echocardiographic evaluation of the cardiopulmonary unit may be difficult in the presence of tricuspid regurgitation (TR) and combined echocardiographic parameters could therefore be useful in such patients. Purpose To assess the variation of simple and combined echocardiographic parameters analysing the cardiopulmonary unit according to the severity of TR. Methods Echocardiographic images were reviewed in 179 patients to assess TR grade according to Hahn’s 5 grades classification. Classical morphological (right ventricle (RV) end diastolic (ED) length and area), function (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), S’ wave, RV free wall longitudinal strain (RVFWS)) and load (TR Time-velocity integral (TR TVI), pulmonary artery systolic pressure (PASP)) parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI x RVFWS), morphology and load (load adaptation index (LAI) = TR TVI x RVED length/area) and morphology, load, and function (myomechanical index (MMI = RV-RA mean pressure gradient x RVFWS/indexed RAED area x 10–2 ) and morphology-load-function index (MLF = RVED length/area x TR TVI x RVFWS)) were calculated. We used receiver operating characteristic (ROC) curve analysis to analyze the diagnostic value of echocardiographic parameters to predict potential high (>3) or low (<6) surgical risk of mortality according to TRISCORE. Results Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of severity of TR. Combined parameters were also significatively different among groups. Among them, MMI and MLF had a linear progression between the 5 groups (MMI: grade 1: 0.20±0.09; grade 2: 0.15±0.08; grade 3: 0.10±0.05, grade 4: 0.09±0.08; grade 5: 0.05±0.04 p = 0.000; MLF: grade 1: 7.56±2.06; grade 2: 6.57±2.14; grade 3: 4.85±2.29, grade 4: 4.79±3.17; grade 5: 3.06±1.82 p = 0.000) and had the best predictive value for TRISCORE high and low risk (MMI: AUC =0.889 p = 0.000 for low risk, 0.855 p = 0.000 for high risk; MLF: AUC =0.873 p = 0.000 for low risk, 0.822 p = 0.000 for high risk). Conclusion Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load parameters. Their good predictive value for TRISCORE risk suggests a potential role of such parameters in the prognostic assessment of TR patients and in the selection for new percutaneous repair techniques.