Non-invasive right ventricular myocardial work in patients with significant tricuspid regurgitation: association with etiology and outcome

Abstract Background/Introduction Right ventricular (RV) function is a key factor in risk stratification of patients with tricuspid regurgitation (TR). Right ventricular myocardial work (RVMW) has been proposed as a novel echocardiographic method to assess RV function, integrating myocardial deformation and afterload. However, data on its application in patients with significant TR, particularly in relation to long-term outcomes, remain limited. Purpose To evaluate RVMW parameters in patients with significant TR in relation to etiology and outcome. Methods Patients with significant (at least moderate-to-severe) secondary TR (STR) diagnosed between 2000 and 2016 were included. Patients without sinus rhythm or with a triangular-shaped early-peaking TR jet at the index echocardiography were excluded to ensure reliable measurements. Patients were classified as having atrial or ventricular STR according to current definitions. RVMW was calculated from RV pressure-strain loops, combining RV longitudinal strain and echo-estimated pulmonary artery pressure. Four RVMW parameters were assessed: RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE). The study endpoint was all-cause mortality. Results A total of 344 patients were included. Patients with atrial STR (n=69) showed significantly lower RVGWW and higher RVGWE than those with ventricular STR (n=275) (38.0 [21.0-61.0] vs 68.0 [37.0-122.5] mmHg%, P