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

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.