Background In patients with significant functional tricuspid regurgitation, timely detection of right ventricular (RV) dysfunction with conventional 2-dimensional echocardiography is challenging, whereas speckle-tracking echocardiography RV free wall longitudinal strain has been proposed as better prognosticator. We evaluated the prevalence and prognostic value of impaired RV free wall longitudinal strain in patients with significant functional tricuspid regurgitation, in comparison with tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). Methods Eight hundred ninety-six patients (51.3% men, 71 years [62-78 years]) with significant functional tricuspid regurgitation were divided according to the presence of RV dysfunction (defined as TAPSE <17 mm, FAC <35%, and RV free wall longitudinal strain >-23%) and were followed for the occurrence of all-cause mortality. Results RV free wall longitudinal strain identified the highest percentage of RV dysfunction (84.9%), in comparison to FAC (48.5%) and TAPSE (71.7%). During a median follow-up of 2.8 years (1.3-5.4 years), 443 (49.4%) patients died. Compared with survivors, nonsurvivors showed worse RV systolic dysfunction (FAC=36.5±12.7% versus 33.9±11.8%, P=0.001; TAPSE=15.4±5.0 versus 14.0±4.5 mm, P<0.001; RV free wall longitudinal strain=-15.9±7.5% versus -12.9±6.8%, P<0.001). Cumulative event-free survival was significantly worse in patients with decreased FAC, decreased TAPSE, and impaired RV free wall longitudinal strain. On multivariate analysis, RV free wall longitudinal strain was independently associated with all-cause mortality and incremental to FAC and TAPSE. Conclusions In significant tricuspid regurgitation, impaired RV free wall longitudinal strain identifies higher rates of RV dysfunction and is associated with worse outcome beyond conventional echocardiographic parameters of RV systolic function.

中文翻译：

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功能性三尖瓣关闭不全患者右室自由壁纵向应变的预后意义。

背景技术对于功能性三尖瓣反流明显的患者，使用常规二维超声心动图及时检测右心室（RV）功能异常具有挑战性，而散斑跟踪超声心动图RV无壁纵向应变已被认为是更好的预后指标。我们评估了功能性三尖瓣关闭不全的患者右室游离壁纵向应变受损的患病率和预后价值，并与三尖瓣环平面收缩期偏移（TAPSE）和面积变化分数（FAC）进行了比较。方法根据RV功能障碍（定义为TAPSE <17 mm，FAC <35％和RV）的存在，对八十六例（51.3％的男性，71岁[62-78岁]）进行功能性三尖瓣关闭不全的划分。自由壁纵向应变> -23％），并跟踪所有原因导致的死亡率。结果与FAC（48.5％）和TAPSE（71.7％）相比，RV无壁纵向应变确定了RV功能障碍的最高百分比（84.9％）。在2.8年（1.3-5.4年）的中位随访期间，有443名（49.4％）患者死亡。与幸存者相比，非幸存者表现出更严重的RV收缩功能障碍（FAC = 36.5±12.7％对33.9±11.8％，P = 0.001; TAPSE = 15.4±5.0对14.0±4.5 mm，P <0.001; RV无壁纵向应变= -15.9 ±7.5％对-12.9±6.8％，P <0.001）。FAC降低，TAPSE降低和RV无壁纵向应变受损的患者的无事件累积生存期显着变差。在多变量分析中，无RV壁的纵向应变与全因死亡率和FAC和TAPSE的增加独立相关。