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The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study

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Abstract

The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (rεR) and strain rate (rSRR). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e′)/rεR. The median age of the sample was 78 (64–84) years, with female gender predominance (63.6 %). The median value of rεR was 16 % (range, 12.7–24.0) and of rSRR was 1.57 s−1 (range, 1.09–2.05). We observed a significant negative correlation between rεR (r = −0.68, p < 0.01) and rSRR (r = −0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for rεR and rSRR, separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with rεR after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower rεR and rSRR that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics.

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Acknowledgments

The authors thank Solange Fernandes, BSc and Susana Pinto, BSc for their help in the echocardiographic evaluation of the patients.

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal

    Rogério Teixeira, João Garcia & Miguel Ribeiro

  2. Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal

    Rogério Teixeira, Rui Baptista & Lino Gonçalves

  3. Hertfordshire Cardiac Centre, Lister Hospital, Stevenage, UK

    Ricardo Monteiro

  4. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Rui Baptista

  5. Serviço de Cardiologia, Hospital da Luz, Lisboa, Portugal

    Nuno Cardim

  6. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra – Hospital Geral, Coimbra, Portugal

    Rogério Teixeira & Lino Gonçalves

Authors
  1. Rogério Teixeira
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  2. Ricardo Monteiro
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  3. João Garcia
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  4. Rui Baptista
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  5. Miguel Ribeiro
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  6. Nuno Cardim
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  7. Lino Gonçalves
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Corresponding author

Correspondence to Rogério Teixeira.

Additional information

RT conceptualized the research, analyzed the data and wrote the manuscript. RM performed the strain analysis and JG performed the strain rate analysis. RM elaborated the database. RT and MAR supervised the standard and advanced echocardiographic measurements. RB, NC and LG actively discussed the results, interpreted the data and reviewed the draft manuscript. RT elaborated the revised manuscript. All the authors have read and approved the manuscript version submitted.

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Supplemental Figure 1

Bland-Altman plot of inter and intra-observer variability. Panel A: Intraobserver variability for rεR. The bias was 0.01%, with a 95% CI: -1.29 to 1.34%. Panel B: Interobserver variability for rεR. The bias was -0.1% with a 95% CI: -3.3 to 3.1%. Panel C: Intraobserver variability for rSRR. The bias was -0.02 s-1 with a 95% CI: -0.24 to 0.19 s-1. Panel D: Interobserver variability for rSRR The bias was -0.03 s-1 with a 95% CI: -0.28 to 0.21 s-1. (pdf 408 kb)

Supplemental Figure 2

Panel A: Median and interquartile range of RV systolic ε for mild (n=23), moderate (n=20) and severe (n=12) TR patients. Panel B: Median and interquartile range of RV systolic SR for mild (n=23), moderate (n=20) and severe (n=12) TR patients. Panel C: Median and interquartile range of (RA reservoir ε – RV systolic SR) for mild (n=23), moderate (n=20) and severe (n=12) TR patients. (pdf 384 kb)

Supplementary material 3 (docx 12 kb)

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Teixeira, R., Monteiro, R., Garcia, J. et al. The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study. Int J Cardiovasc Imaging 31, 1125–1135 (2015). https://doi.org/10.1007/s10554-015-0663-5

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  • DOI: https://doi.org/10.1007/s10554-015-0663-5

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