Mortality Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation

Lior Zornitzki; Ophir Freund; Shir Frydman; Zach Rozenbaum; Yoav Granot; Shmuel Banai; Yan Topilsky

doi:10.1016/j.echo.2024.10.012

Mortality Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation

J Am Soc Echocardiogr. 2024 Oct 30:S0894-7317(24)00557-1. doi: 10.1016/j.echo.2024.10.012. Online ahead of print.

Authors

Lior Zornitzki¹, Ophir Freund², Shir Frydman², Zach Rozenbaum³, Yoav Granot⁴, Shmuel Banai⁴, Yan Topilsky⁴

Affiliations

¹ Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv; School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: lior.zoz@gmail.com.
² School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine B, Tel-Aviv Sourasky Medical Center, Tel Aviv.
³ Department of Cardiology, Tulane University, New Orleans, LA, USA.
⁴ Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv; School of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 39486691
DOI: 10.1016/j.echo.2024.10.012

Abstract

Background: Tricuspid-annular-plane-systolic-excursion (TAPSE) and peak-lateral-tricuspid-annular-systolic-velocity (S') are echocardiographic indices of right-ventricle (RV) function. The abnormality thresholds for these parameters are based on data obtained from healthy adults, rather than outcome data.

Objectives: We aimed to re-examine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with, or without, significant tricuspid regurgitation (TR).

Methods: We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011-2021. TR was assessed using a semi-quantitative method. Cut-off values associated with excess mortality were assessed using spline curves in univariate, and multivariate Cox analyses.

Results: A total of 24717 subjects were included in the current analysis. 1143 (4.6%) subjects had clinically significant (≥moderate) TR. In the entire cohort, TAPSE<20.9 mm and S' <10.9 cm/s were associated with excess mortality. In sub-group analysis, among subjects with significant TR, TAPSE<18.0 mm and S'<10.0 cm/s was the cutoff associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE<21.5 mm and S'<10.9 cm/s. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE<20.9 mm (HR 1.16, 95% CI 1.10-1.23; p<0.001) and S'<10.9 cm/s (HR 1.09, 95% CI 1.04-1.20; p=0.01) were independently associated with mortality.

Conclusion: TAPSE and S' thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S' cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.

Keywords: Mortality; Peak lateral-tricuspid annular systolic-velocity (S’); RV function; Tricuspid Regurgitation (TR); Tricuspid-annular-plane-systolic-excursion (TAPSE).