Right ventricular reverse remodeling, but not subjective clinical amelioration, predicts long-term outcome after surgery for isolated severe tricuspid regurgitation.
BACKGROUND
Subjective clinical improvement does not always go hand-in-hand with right ventricular (RV) reverse remodeling after surgery for isolated severe tricuspid regurgitation (TR). This study aimed to evaluate the level of agreement between clinical improvement and echocardiographic RV reverse remodeling, and determine the relative prognostic powers of these 2 factors in terms of long-term prognosis for patients with isolated TR surgery.


RESULTS
Sixty-one consecutive patients (58±8 years) were included. During a median follow up of 55 months (IQR, 36.5∼71.5 months), a composite endpoint including death and admission for right heart failure was investigated. Extents of reductions in RV end-systolic area (RV-ESA) and subjective clinical improvement at 6 months were examined. There were 6 deaths and 5 admissions for right heart failure. A reduction in RV-ESA of >20% effectively predicted event-free survival, with a sensitivity of 90.9% and a specificity of 72.0% (AUC 0.81, P=0.001). With this cut-off, the agreement between a clinical and echocardiographic response was only 57.4% (35 patients). On Cox regression analysis, RV-ESA change emerged as the only independent predictor of event-free survival, whereas subjective clinical improvement did not.


CONCLUSIONS
A discrepancy between subjective and echocardiographic improvement at 6 months after isolated TR surgery was observed in 42.6% of the patients. Echocardiographic RV reverse remodeling, but not subjective clinical amelioration, was a strong prognosticator after surgery.
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital.
Ji-Hyun
JH
Kim
Hyung-Kwan
HK
Kim
Seung-Pyo
SP
Lee
Yong-Jin
YJ
Kim
Goo-Yeong
GY
Cho
Kyung-Hwan
KH
Kim
Ki-Bong
KB
Kim
Hyuk
H
Ahn
Dae-Won
DW
Sohn
D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D020257:Ventricular Remodeling