Background: Chronic significant TR imposes a volume overload to the RV leading to a progressive RV dilatation and dysfunction. A comprehensive assessment of RV function is of paramount importance to guide the therapeutic management of these patients; however, it remains challenging, particularly in presence of altered loading conditions.

Aim: The aim of this meta-analysis was to systematically investigate the prognostic value of right ventricular (RV) function in patients with significant (at least moderate, ≥ 2+) tricuspid regurgitation (TR).

Methods: MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to July 2022. Studies reporting data on at least one echocardiographic RV function parameter and outcome in patients with significant TR were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause long-term mortality (more than one year).

Results: Out of 3,152 studies, a total of 10 were included in the analytic synthesis, enrolling 3435 subjects. The median follow-up in our study population was 28 [22 – 70] months. All-cause long-term mortality was 40% (95% confidence interval [CI]: 32-49%, p = 0.028; Figure 1). To explore the potential impact of effect size modifiers on all-cause long-term mortality, we performed a meta-regression analysis of the baseline characteristics of the included studies. At long-term, a significant relation was found between RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue doppler imaging systolic velocity (TDI s’) and mortality. In particular, RV-FAC was associated with reduced incidence of all-cause mortality [7 studies enrolling 2,611 subjects, intercept 5.18, slope -0.15, P = 0.007; Figure 2]; whereas both TAPSE and TDI s’ were unsatisfactory to predict the outcome in these patients [TAPSE 9 studies enrolling 2,891 subjects, intercept 1.73, slope -0.12, P = 0.36; TDI s’ 5 studies enrolling 1429 subjects, intercept -2.06, slope 0.15, P = 0.78]. Interestingly, diabetes mellitus (DM) and hyperlipidaemia were associated with an increased risk of mortality [DM 9 studies enrolling 3371 subjects, intercept -2.62, slope 0.09, P = 0.004; hyperlipidaemia 6 studies enrolling 2338 subjects, intercept -2.91, slope 0.05, P = 0.01].

Conclusions: Significant TR is associated with increased risk of all-cause mortality. To our knowledge, this is the first study to demonstrate that only RV-FAC, and not conventional echocardiographic indexes of RV longitudinal function, correlates with adverse outcomes in patients with significant TR.

Figure 1.

Figure 1. Forest plot for the incidence of long-term all-cause mortality of patients with significant tricuspid regurgitation

Figure 2.

Figure 2. Plot showing the result of the meta-regression analysis for the relationship between RV-FAC and all-cause mortality.