Background: In patients with isolated severe tricuspid regurgitation (TR), corrective surgery improved right ventricular (RV) systolic function associated with RV reverse remodeling (RRM). However, it is unknown whether RV RRM translates into a better long-term prognosis and what extent of RRM is clinically relevant, which were investigated in this study.
Methods and Results: Patients (n=61) with severe TR (58 짹 8 years; 89% women) who underwent isolated corrective TR surgery were followed up for 51 짹 25months. The extent of reduction in RV end-systolic area (RVESA) at 6 months relative to baseline was examined for its predictive value on long-term outcomes. The cutoff value for RV RRM in predicting mortality was derived from the receiver operating characteristic (ROC) curve. Then the relation between potential predictors of mortality and heart failure (HF) hospitalizations were compared by Kaplan-Meier analysis, followed by Cox regression analysis. There were 7(11.3%) deaths and 14(23.6%) HF hospitalization. The ROC curve found that a reduction in RVESA of <20% had a sensitivity of 88% and specificity of 57% in predicting cardiac death. With this cutoff value, there were 50(81%) responders to RRM. Responders had significantly lower HF hospitalization (16 vs. 50%, P=0.001) and cardiac death (19.6 vs. 50%, P=0.001) than non-responders. In the Cox regression model, the change in RVESA was the single most important predictor of outcomes including HF and cardiovascular mortality (�� = -1.65, C.I. 0.05 to 0.75, P=0.02). The improvement of clinical parameters was unable to predict long-term cardiovascular outcomes.
Conclusions: A reduction in RVESA of 20% signifies clinically relevant reverse remodeling, which is a strong predictor of lower long-term cardiovascular events. This study suggests that assessing planimetric changes after the corrective surgery in patients with severe TR provides information predictive of postoperative outcomes.