Impact of functional tricuspid regurgitation on heart failure and death in patients with functional mitral regurgitation and left ventricular dysfunction

Abstract

AimsThe prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR. Methods and resultsWe enrolled 373 consecutive patients (mean age 68 + 11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1-120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36 + 2% and 55 + 4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-2.1, P ¼ 0.01) was an independent determinant of HF. The incidence of HF was 41 + 5, 46 + 7, 57 + 7, and 65 + 8% for patients without, and with mild, moderate, and severe FTR respectively (P ¼ 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5 + 2% and 60 + 3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2-2.1, P ¼ 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69 + 2.5, 67 + 2.1, 51 + 2.5, and 40 + 4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P ¼ 0.004). ConclusionsModerate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.--

Prevalence, Predictors, and Prognostic Value of Residual Tricuspid Regurgitation in Patients With Left Ventricular Assist Device

“…Functional TR in the absence of leaflet abnormalities frequently occurs in patients with heart failure by annulus dilatation and leaflet tethering1, 2, 3 and is associated with unfavorable outcomes 8, 9, 10, 11. Koelling et al demonstrated that severe functional TR was an independent predictor for all‐cause mortality in 1421 patients with LVEF <35% 9.…”

“…Koelling et al demonstrated that severe functional TR was an independent predictor for all‐cause mortality in 1421 patients with LVEF <35% 9. Agricola et al showed that moderate‐to‐severe functional TR was an independent determinant of overall mortality in 373 patients with heart failure during median follow‐up of 32 months 10. LVAD is an effective therapeutic option for end‐stage heart failure.…”

“…The TR jet area on color flow mapping and right atrium in the same frame was measured by planimetry, and the ratio of the maximal regurgitant area to right atrium area (%TR) was then obtained. TR severity was graded as follows based on Framingham Heart Study criteria: mild if the %TR was up to 19%; moderate if 20% to 40%; or severe if ≥41% 10, 12, 22. Significant TR was defined as moderate or severe TR (≥20% of %TR).…”

“…The occurrence of TR initiates a vicious cycle of further RV dilatation and dysfunction and, consequently, worsening of TR 7. TR severity is independently associated with worse survival in heart failure patients8, 9, 10, 11 as well as in patients with isolated TR 12, 13…”

Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

“…6 To our knowledge, there are no published studies on whether the presence of PH in the non-ischemic heart with a reduced ejection fraction (EF) affects hemodynamic parameters and clinical outcome. We used cardiac catheterization with a micromanometer to investigate the relationship between PH and cardiac function, as well as the association between PH and clinical outcome, namely cardiac death or hospitalization for worsening HF, in ambulatory patients with DCM.…”