Association of echocardiographic diastolic tricuspid regurgitation with other echocardiographic parameters, survival scores and functional capacity in patients with advanced functional mitral regurgitation

Aims: Functional mitral regurgitation (FMR) is an important condition associated with advanced heart failure and poor prognosis. The aim of this study was to investigate the effects of diastolic (presystolic) tricuspid regurgitation (DTR) on right ventricular function, survival rates and functional capacity in patients with advanced FMR. The relationship between DTR and right ventricular systolic function and the predictive factors involved in its development were also evaluated. Methods: The study included 64 patients with advanced FMR who were evaluated for mitraclip therapy between June 2014 and February 2015. Demographic characteristics, cardiovascular risk factors, New York Heart Association (NYHA) functional classification and laboratory data were recorded. Left and right ventricular parameters were examined by echocardiography, and the diagnosis of DTR was made by color Doppler method. Estimated survival rates were evaluated using the Seattle Heart Failure Model Score (SHFSM) with 1- and 5-year projections. Results: DTR was detected in 14 (22%) of the patients included in the study. The majority (85.7%) of the patients in the group with DTR were in NYHA III-IV stage and had low functional capacity. DTR showed significant assocation with right ventricular fractional area change (RV FAC), right ventricular peak systolic myocardial velocity (RV Sm), TAPSE, tricuspid regurgitation, ejection fraction, pulmonary artery systolic pressure, and pulmonary vascular resistance (p<0.05). In addition, DTR group had lower estimated survival rates compared to SHFSM (1-year estimated survival 64%, 5-year estimated survival 35%; p<0.001). In Binary Logistic Regression Analysis, RV FAC and RV Sm values were found to be independent predictors for the development of DTR. Conclusion: DTR is an important echocardiographic parameter that indicates poor prognosis in patients with advanced FMR. This study demonstrated that DTR is associated with right ventricular dysfunction and decreased estimated survival rates. Early diagnosis of DTR may provide an important contribution to clinical management and prognostic evaluation in this patient group.