Mortality-Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation

Background: Tricuspid annular plane systolic excursion (TAPSE) and peak lateral tricuspid annular systolic velocity (S’) are echocardiographic indices of right ventricle function. The abnormality thresholds for these parameters are based on data obtained from healthy adults rather than outcome data. Objectives: We aimed to reexamine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with or without significant tricuspid regurgitation (TR). Methods: We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011 and 2021. Tricuspid regurgitation was assessed using a semiquantitative method. Cutoff values associated with excess mortality were assessed using spline curves in univariate and multivariate Cox analyses. Results: A total of 24,717 subjects were included in the current analysis. A total of 1,143 (4.6%) subjects had clinically significant (moderate or more) TR. In the entire cohort, TAPSE <20.9 mm and S’ <10.9 cm/sec were associated with excess mortality. In subgroup analysis, among subjects with significant TR, TAPSE <18.0 mm and S' <10.0 cm/sec were the cutoffs associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE <21.5 mm and S' <10.9 cm/sec. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE <20.9 mm (hazard ratio = 1.16; 95% CI, 1.10-1.23; P <.001) and S’ <10.9 cm/sec (hazard ratio =1.09; 95% CI, 1.04-1.20; P =.01) were independently associated with mortality. Conclusions: The TAPSE and S’ thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S′ cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.