Impaired right atrial reservoir strain assessed by echocardiography is independently associated with all-cause mortality in patients with moderate-to-severe tricuspid regurgitation.
Key Findings
Results
Lower right atrial reservoir strain (RArS) was independently associated with higher all-cause mortality in patients with moderate-to-severe tricuspid regurgitation.
Multivariable analysis showed odds ratio of 0.92 (95% CI, 0.85–0.99; P=0.04) for all-cause mortality per unit decrease in RArS
The cohort included 239 patients (mean age 82 years, 55% women) with TR grade ≥+3
Median RArS was 11.7%, used as the threshold to divide the cohort into two groups
During a median follow-up of 26 months (IQR, 8–31), 99 of 239 patients (41%) died
Results
Patients with RArS below the median had significantly lower survival rates compared to those with RArS at or above the median.
Survival rate was 30% in patients with RArS <11.7% versus 52% in patients with RArS ≥11.7% (P<0.001)
The difference in survival was statistically significant at a median follow-up of 26 months
This represents a clinically meaningful difference of 22 percentage points in survival
Results
Patients with lower RArS had worse right ventricular function and a higher rate of atrial fibrillation compared to those with higher RArS.
Patients with RArS below median had a higher rate of atrial fibrillation
Worse right ventricular function was observed in the lower RArS group
Lower RArS was also associated with wider inferior vena cava diameter, abnormal cholestatic liver enzymes, and a higher rate of diuretic use
These findings suggest that lower RArS reflects more advanced systemic consequences of tricuspid regurgitation
Methods
RArS was measured using 2-dimensional speckle-tracking echocardiography in a consecutive cohort of patients with significant tricuspid regurgitation.
289 consecutive patients with TR grade ≥+3 were analyzed, of whom 239 were included in the final study
RArS was evaluated using semiautomated software (TOMTEC; Philips)
Clinical, laboratory, and echocardiographic data were collected and analyzed
The cohort had a mean age of 82 years and was 55% women, reflecting an elderly population
Conclusions
The authors proposed that serial measurement of RArS could potentially aid in optimizing the timing for tricuspid valve intervention.
The authors stated that 'serial measurement of RArS can potentially aid in optimizing timing for intervention in patients with TR'
RArS reflects mechanical remodeling of the right atrium as the receiving chamber for regurgitant volume
The right atrium undergoes significant mechanical remodeling in significant TR, making it a relevant target for strain assessment
What This Means
This research suggests that measuring the stretchability (or 'strain') of the right atrium—the heart chamber that receives blood flowing back through a leaky tricuspid valve—can predict survival in patients with moderate-to-severe tricuspid regurgitation (TR). Using a specialized ultrasound technique called speckle-tracking echocardiography, the researchers measured right atrial reservoir strain (RArS) in 239 elderly patients (average age 82 years) and followed them for a median of about two years. They found that patients with lower RArS (below 11.7%) had a survival rate of only 30%, compared to 52% in patients with better atrial function, and this relationship held up even after accounting for other health factors.
Patients with poorer right atrial strain also tended to have more atrial fibrillation, worse right heart function, signs of liver congestion, and greater reliance on diuretic medications—all indicators that the disease was more advanced and taking a toll on the body. This suggests that the right atrium's mechanical performance reflects broader disease severity in TR patients, not just a local structural change.
This research suggests that routinely measuring right atrial strain during echocardiograms could help doctors identify which tricuspid regurgitation patients are at highest risk of dying and potentially guide decisions about when to intervene surgically or with a catheter-based procedure. Since tricuspid regurgitation is increasingly recognized as a serious condition affecting older adults, having a reliable, non-invasive marker like RArS could improve how and when treatment is offered.
Merin R, Zornitzki L, Zahler D, Shporn O, Granot Y, Banai S, et al.. (2026). Prognostic Value of Right Atrial Strain in Patients With Moderate-to-Severe Tricuspid Regurgitation.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.046306