Prognostic significance of tricuspid annular motion and plasma NT-proBNP in patients with heart failure and moderate-to-severe functional mitral regurgitation

Background: The role of the right ventricle has been relatively neglected proportionate to its importance. We sought to evaluate the impact of right ventricular (RV) and NT-proBNP on the outcome of patients with heart failure (HF) and functional mitral regurgitation (MR). Methods and patients: Outpatients with left ventricular (LV) systolic HF (ejection fraction [EF] <= 45%) and moderate-to-severe MR measured by a vena contracta width >= 0. 5 cm were prospectively enrolled (n = 142). Indexes of LV and RV function, including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change and tissue Doppler RV acceleration at isovolumic contraction and NTproBNP plasma levels were measured at the time of the index echocardiogram. Results: Multivariate predictors of all-cause mortality included TAPSE < 16 turn (hazards ratio [HR]: 2.64; p=0.009) and plasma NTproBNP >= 3283 pg/ml (HR: 2.58; p=0.011). TAPSE < 16 mm and plasma NT-proBNP >= 3283 pg/ml added incremental prognostic information to LV EF <= 25%, NYHA classes 3-4, coronary artery disease, elderly age and male sex. The 36-month Kaplan-Meier curve showed that survival was worst in the group with TAPSE < 16 min and NT-proBNP >= 3283 pg/ml (p < 0.0001). Conclusion: This study demonstrates the significance of TAPSE and plasma NT-proBNP in predicting all-cause mortality in patients with systolic HF and moderate-to-severe functional MR. (c) 2009 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.