Significant Secondary Tricuspid Regurgitation May Be Associated With More Pronounced RV Systolic Dysfunction

Patients with vs without significant secondary tricuspid regurgitation (STR) were found to have more pronounced right ventricular (RV) systolic dysfunction, according to a study published in the American Journal of Cardiology.

In this study, investigators sought to examine the prevalence of RV dysfunction assessed with speckle tracking echocardiography (STE) in patients with vs without significant STR (ie, ≥3+ and <3+, respectively) and comparable 3-dimensional RV dimensions and RV ejection (RVEF) evaluated on dynamic computed tomography (CT). Participants with dynamic CT data before transcatheter aortic valve implantation were evaluated retrospectively.

Patients were matched 1:1 according to age, sex, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF) to assess the performance of RV-free wall strain (RVFWS) in detecting impaired RV systolic function. Of the 267 patients (mean age, 80±8 years; 48% men) in this cohort, significant STR was observed in 67 participants.

Patients with vs without significant STR had larger RVEDVi and RVESVi, lower LVEF, and more impaired RVFWS. After propensity score matching, patients with STR ≥3+ (n=53) had more impaired RVFWS compared with patients with STR <3+ (n=53; -18.2±5.0% vs -21.1±3.7%, respectively; P =.001).

Study limitations include its single-center retrospective design, and the sole inclusion of patients who had undergone TAVI.

“This study demonstrates that RV function in patients with significant STR is more frequently impaired when measured with RVFWS than by assessment of 3-dimensional RVEF,” noted the study authors. “In the non-matched cohort, significant STR was associated with RV and LV remodeling, but after matching for LVEF, RV volumes, and RVEF, the RVFWS remained significantly more impaired in patients with significant STR compared to without significant STR,” they added.

“The clinical implications of these findings are important, since RV systolic function has demonstrated to be an important prognostic marker in various cardiac conditions.”

Disclosures: Some of the authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Hirasawa K, van Rosendael PJ, Dietz MF, et al. Comparison of the usefulness of strain imaging by echocardiography versus computed tomography to detect right ventricular systolic dysfunction in patients with significant secondary tricuspid regurgitation [published online August 14, 2020]. Am J Cardiol. doi: