ATRIAL SECONDARY TRICUSPID REGURGITATION

Echocardiographic studies prospectively acquired from patients with secondary tricuspid regurgitation (STR) between October 2010 and March 2022. Inclusion criteria were age >18 years and presence of STR. Atrial STR was defined by the presence of STR in patients with a clinical history of atrial fibrillation (AF), normal left ventricular (LV) systolic function, normal right ventricular (RV) size and/or function, and pulmonary artery systolic pressure (PASP) lower than 50 mmHg (2). The rest of the patients were included in the ventricular STR phenotype. Exclusion criteria were primary TR, cardiac implantable electronic device (CIED)-related TR (leaflet impingement, adherence, etc.), previous TV surgery or transcatheter treatment, pregnancy, poor apical acoustic window with inadequate echocardiographic images, and lack of follow-up data. 

The primary study endpoint was the occurrence of death for any cause or hospitalization for HF. Information concerning survival and hospitalization was obtained at regular intervals via (i) telephone interview with the patient, or if deceased, with family members; (ii) contact with the patient’s physician(s); and (iii) review of electronic medical records of regular outpatient visits and hospital admission records. Mortality status was verified independently through the Social Security Death Index and death certificates. Cause of death was determined based on a review of death certificates, post-mortem exam reports when available, medical records for patients who died while hospitalized, and contact of patient’s physician(s), and it was classified as cardiac or non-cardiac death. HF hospitalization was defined as admission for more than 24 hours with a primary diagnosis of HF, characterized by symptoms, signs, laboratory and/or invasive HF findings, and HF-specific treatment implementation. Assignment of clinical events was performed by physicians unaware of the patient's echocardiographic data. For patients without events, the date of last contact was used for survival analysis.