title: The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study.
abstract: The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (rεR) and strain rate (rSR(R)). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e')/rε(R). The median age of the sample was 78 (64-84) years, with female gender predominance (63.6%). The median value of rε(R) was 16% (range, 12.7-24.0) and of rSR(R) was 1.57 s(-1) (range, 1.09-2.05). We observed a significant negative correlation between rε(R) (r = -0.68, p < 0.01) and rSR(R) (r = -0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for rε(R) and rSR(R), separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with rε(R) after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower rε(R) and rSR(R) that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics.
authors.affiliation: Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal, rogeriopteixeira@gmail.com.
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.forename: Ricardo
authors.initials: R
authors.lastname: Monteiro
authors.forename: João
authors.initials: J
authors.lastname: Garcia
authors.forename: Rui
authors.initials: R
authors.lastname: Baptista
authors.forename: Miguel
authors.initials: M
authors.lastname: Ribeiro
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D004548:Elasticity; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015999:Multivariate Analysis; D011174:Portugal; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left