Right Heart Remodeling and Outcomes in Patients With Tricuspid Regurgitation A Literature Review and Meta-Analysis

BACKGROUND Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR). OBJECTIVES This meta -analysis aimed to investigate the association between right heart remodeling and long-term ( > 1 year) all -cause mortality in patients with signi ficant TR (at least moderate, $2 + ). METHODS MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all -cause mortality in patients with signi ficant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta -Analyses) requirements. RESULTS Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all -cause mortality was 31% (95% CI: 20%-41%; P # 0.001). By means of meta -regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, - 6.3% [95% CI: - 11.1% to - 1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, - 4.4% [95% CI: - 5.9% to - 2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, - 4.1% [95% CI: - 7.6% to - 0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, - 1.9% [95% CI: - 2.5% to - 1.3%]; P < 0.001) and mortality. CONCLUSIONS RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667) (J Am Coll Cardiol Img 2024;17:595 -606) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).