Right Ventricle Remodeling Patterns in Severe Tricuspid Regurgitation- Insight from a Longitudinal Study

Objective:

Among patients with severe tricuspid regurgitation (TR), those with pulmonary hypertension (PHT) have poorer prognosis. It has been proposed that PHT may result in a unique type of right ventricle (RV) remodeling, but longitudinal information on RV remodeling in the presence or absence of PHT has not been described. The aim was to determine whether PHT in patients with severe TR results in a different pattern of RV remodeling and dysfunction compared to patients with TR without PHT.

Methods:

From our echo database, we identified patients with severe TR with (systolic pressure>50mmHg, N=48) or without PHT (N=117) who had ≥1 additional TTE within five years prior to the index TTE. Included were 396 TTEs (165 index studies and 231 preceding studies).

Results:

During the five years preceding the index TTE, patients with severe TR developed increasing RVOT diameter (p=0.04), basal diameter (p=0.02), mid diameter (p=0.0005), RA area (p=0.01) and Tei index (p=0.02), and decreasing S` (p<0.00001), and TAPSE (p<0.0001) without change of RV length or fractional area change. Patients with PHT demonstrated the greatest increase in mid RV diameter, but otherwise there were no significant differences in RV remodeling or evolution of dysfunction between the groups (P=NS for all group comparisons, and all group by time interaction).

Conclusions:

The evolution to severe TR (from lesser degrees of TR) is associated with marked changes in basal, mid and RVOT size, combined with decrease in longitudinal (but not radial) contraction. PHT is associated with a distinct presentation of severe TR preceded by a unique remodeling pathway, exaggerated in the mid ventricular area.