Despite the perception that the right ventricle (RV) is somewhat of a passive conduit, recent studies claim that RV function is an independent prognostic factor in patients with severe tricuspid regurgitation.

We sought a better understanding of the coupling between RV function and remodelling, as it might improve the accuracy of the prognostic stratification of patients with severe tricuspid regurgitation.

Transthoracic echocardiography was performed in 103 consecutive patients with mild to moderate (n=60) and severe (n=43) tricuspid regurgitation for RV diameter, TAPSE and tricuspid tissue Doppler peak S velocity.

Twenty-seven patients died and 36 patients had reoccurrence of heart failure during a 12-months follow-up. Right ventricular systolic function and remodelling were linearly correlated (P<0.01, whichever the parameter used). Using Cox proportional hazard, all parameters of RV function and remodelling were independent prognostic predictors (P<0.05). We found that RV function was preserved in some patients with severe tricuspid regurgitation and that the prognosis of these patients was similar to that of the patients with mild- to moderate tricuspid regurgitation irrespective of dilatation. Only patients with severe TR and combining RV dilatation/systolic dysfunction had additional risk.

This study supports the importance of combining right ventricular function and remodelling when assessing the individual risk of tricuspid regurgitation.