Factors associated with cardiac events in patients with severe tricuspid regurgitation who underwent exercise stress echocardiography

Abstract Backgrounds The poor prognosis of patients with severe tricuspid regurgitation (TR) has been reported. However, there are few reports on the relationship between echocardiographic parameters during exercise and cardiac events. Objective We aimed to identify the incidence rates of cardiac events and their associated factors in patients with severe TR who underwent exercise stress echocardiography (ESE). Methods We registered 124 consecutive patients with severe TR who underwent ESE. The causes of TR were divided into secondary TR due to atrial fibrillation, secondary TR associated with pulmonary hypertension due to left ventricular or left atrial dysfunction, and primary TR. Backgrounds and echocardiographic parameters during exercise were investigated. The outcome of cardiac events was a composite of cardiac death and hospitalization for heart failure. Results Cardiac events occurred in 42 patients (34%) during a median follow-up period of years. Between patients with (n=42) and without (n=84) cardiac events, no differences were shown in age, sex, the etiology, haemodynamics before and after ESE (blood pressure, cardiac output, and TR pressure gradient), and LV function, including ejection fraction and LV global longitudinal strain. Conversely, the indices of right ventricle (RV) function before and after exercise, including TAPSE, S’, FAC, and RV free wall strain (RVFWS), % peak VO2, and VE/VCO2 slope were worse in patients with cardiac events than those without cardiac events. Among those indices of RV function, RVFWS at rest and peak workload showed the best predictive ability of cardiac events (Rest: AUC 0.71, cut-off value -22.0%: Sensitivity 70%, Specificity 63%, HR 1.13 per 1% worsening: 95% CI 1.06–1.20, p