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Rapid Fire Abstracts

Rapid Fire 04- Clinical Outcome and Prognosis I

Non-ischemic septal fibrosis in advanced tricuspid regurgitation is an independent predictor of all-cause-mortality – a multimodality imaging study (RF_TH_259)

Thursday, January 30, 2025
5:30 PM – 5:40 PM East Coast USA Time
Location: Blue Room PreFunction
Background: Non-ischemic septal fibrosis (NIsF) on cardiac magnetic resonance (CMR) has been linked to poor prognosis in patients with right ventricular dysfunction, but its prognostic impact in tricuspid regurgitation has not been well-characterized.

Methods: The population comprised patients with advanced functional TR (≥moderate) who underwent cine- and late gadolinium enhancement (LGE)-CMR. 580 patients also underwent transthoracic echo (TTE) within a 3 month-interval. LGE-CMR was used to detect myocardial scars or infarction, including non-ischemic septal fibrosis (NIsF), defined as hyperenhancement restricted to the mid-myocardial or epicardial layers of the interventricular septum. Clinical characteristics including follow-up and all-cause mortality were obtained blinded to imaging analyses.

Results: A total of 943 patients (average age 71±15 years; 52% male) with advanced functional TR who underwent CMR were studied. More than half (52%) of the population had LV scar or infarction as detected by LGE-CMR (9.2±11.0% of LV myocardium), with 51.4% (n=247) of them representing non-ischemic septal fibrosis (NIsF). The prevalence of NIsF was three times higher in patients with concurrent RV dysfunction compared to those without (35.9% vs. 13.0%, p< 0.001). During a median follow-up of 3.2 years [IQR 0.54, 7.76], all-cause mortality rate was 24.3% (n=229). As shown in Table 1, RV dysfunction, LV and RV dilation, advanced mitral regurgitation, pulmonary hypertension, and NIsF were each associated with increased mortality risk in univariable analysis (p< 0.05 for all). In multivariable analysis, NIsF conferred a 1.7-fold increase in mortality risk even after adjusting for age, RV dysfunction, and pulmonary hypertension (p=0.005). Kaplan-Meier survival curves inclusive of NIsF and pulmonary hypertension demonstrates mortality risk to increase stepwise in relation to both myocardial tissue alteration and RV afterload with the highest risk of death among patients with both NIsF and pulmonary hypertension (p< 0.001) (Figure 1).

Conclusion: NIsF is strongly linked to increased mortality risk in patients with advanced tricuspid regurgitation, supporting the concept that myocardial tissue alterations have the potential to provide incremental prognostic risk stratification beyond traditional risk factors among patients with tricuspid valve disease.