The Impact of Right Atrial Function on Prognosis and Renal Function in Tricuspid Regurgitation Patients.

Tricuspid regurgitation (TR) is related to survival and right atrial (RA) size and function may play a role. Our objective is to assess the impact of RA function measured by strain (RAS) on outcome and end organ congestion. We enrolled 134 patients (mean age 73 ± 13 years, 62% women) with any TR grade or etiology and a complete echocardiogram, clinical follow up and renal function assessment. Primary endpoint was a combination of overall mortality and right-sided heart failure hospitalization (HFH), and secondary endpoint was worsening renal function (WRF). After a median follow up of 23.5 months (interquartile range 12-34 months), the combined endpoint was reached by 31% of patients. Patients with RAS ≤18% showed lower event-free survival (LogRank p<0.001). In multivariable analysis RAS ≤18% (HR 3.1, 95% CI 1.1-8.8) and pulmonary artery systolic pressure (PASP, HR 1.02, 95% CI 1-1.05) were independent predictors of the primary endpoint. Patients with RAS ≤18% and PASP >45 mmHg had the worst outcome (HR 4.3, 95% CI 2-9.5). RAS ≤18% (OR 3.22, 95% CI 1.11-9.33) and PASP >45 mmHg (OR 3.2, 95% CI 1.15-8.88) were independent predictors of WRF adjusting for TR severity, left and right ventricular function, age, sex, diabetes, diuretics, atrial fibrillation. The addition of RAS ≤18% had incremental power over PASP and echocardiographic variables of TR severity and right or left ventricular function to predict WRF (p=0.026). In conclusion, RA function measured by RAS independently predicts mortality and hospitalizations in TR patients, also independently and incrementally predicts WRF over time.