Impact of tricuspid regurgitation on survival in patients with chronic heart failure: unexpected findings of a long-term observational study

Neuhold, Stephanie; Huelsmann, M; Pernicka, Elisabeth; Gráf, Alexandra; Bonderman, Diana; Adlbrecht, Christopher; Binder, Thomas; Maurer, Gerald; Pacher, Richard; Mascherbauer, Julia

doi:10.1093/eurheartj/ehs465

Cited by 157 publications

(116 citation statements)

References 27 publications

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“…These findings are consistent with those previously published (16,17) in patients with chronic heart failure where moderate/severe TR was associated with increased risk of mortality.…”

Section: J a C C : C A R D I O V A S C U L A R I N T E R V E N T I Osupporting

confidence: 93%

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Tricuspid Regurgitation Is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction

Dahou

Magné

Clavel

et al. 2015

JACC: Cardiovascular Interventions

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“…These findings are consistent with those previously published (16,17) in patients with chronic heart failure where moderate/severe TR was associated with increased risk of mortality.…”

Section: J a C C : C A R D I O V A S C U L A R I N T E R V E N T I Osupporting

confidence: 93%

“…Several studies have reported an increased risk of mortality in chronic heart failure patients having moderate or severe TR (9,14,16,17).…”

mentioning

confidence: 99%

Tricuspid Regurgitation Is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction

Dahou

Magné

Clavel

et al. 2015

JACC: Cardiovascular Interventions

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“…Moderate‐to‐severe TR is present in 30% to 50% of patients with severe mitral regurgitation and in 12% to 25% of patients with severe aortic stenosis 4, 24, 25, 26, 27, 28. TR has been shown to be an independent negative predictor of long‐term survival among the following: (1) patients with multivalvular disease undergoing surgical or transcatheter aortic and mitral valve treatment,1, 2, 4, 25 (2) patients with heart failure who are treated medically,24, 29 and (3) patients with severe isolated TR who are treated medically 30, 31. There is also a growing body of evidence suggesting a potential mortality benefit of early treatment of TR in both patients with isolated TR and those with TR concomitant with mitral valve disease 23, 30, 32.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation

Alqahtani

Berzingi

Aljohani

et al. 2017

JAHA

145

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BackgroundTricuspid regurgitation (TR), if untreated, is associated with an adverse impact on long‐term outcomes. In recent years, there has been an increasing enthusiasm about surgical and transcatheter treatment of patients with severe TR. We aim to evaluate the contemporary trends in the use and outcomes of tricuspid valve (TV) surgery for TR using the National Inpatient Sample.Methods and ResultsBetween January 1, 2003 and December 31, 2014, an estimated 45 477 patients underwent TV surgery for TR in the United States, of whom 15% had isolated TV surgery and 85% had TV surgery concomitant with other cardiac surgery. There was a temporal upward trend to treat sicker patients during the study period. Patients who underwent isolated TV repair or replacement had a distinctly different clinical risk profile than those patients who underwent TV surgery simultaneous with other surgery. Isolated TV replacement was associated with high in‐hospital mortality (10.9%) and high rates of permanent pacemaker implantation (34.1%) and acute kidney injury requiring dialysis (5.5%). Similarly, isolated TV repair was also associated with high in‐hospital mortality (8.1%) and significant rates of permanent pacemaker implantation (10.9%) and new dialysis (4.4%). Isolated TV repair and TV replacement were both associated with protracted hospitalizations and substantial cost.ConclusionsIn contemporary practice, surgical treatment of TR remains underused and is associated with high operative morbidity and mortality, prolonged hospitalizations, and considerable cost.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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…”

Section: Introductionmentioning

confidence: 99%

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

Nakanishi

Homma

Han

et al. 2018

JAHA

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BackgroundAlthough implantation of a left ventricular assist device (LVAD) generally improves tricuspid regurgitation (TR) in short‐term follow‐up, the clinical significance of residual TR in patients with mid‐ to long‐term LVAD support is unknown. This study aimed to identify the prevalence, predictors, and prognostic value of residual TR in LVAD patients in association with tricuspid valve (TV) deformation.Methods and ResultsThe study cohort consisted of 127 patients who underwent LVAD implantation without TV procedure and were supported with LVAD at least 1 year. All patients underwent echocardiographic examination preoperatively and 1 year after LVAD implantation. TR was quantitatively assessed by ratio of TR color jet area/right atrial area, and significant residual TR was defined as ≥20% of %TR at follow‐up echocardiographic examination. Detailed echocardiographic measurements were also performed, including TV annulus diameter, TV leaflet displacement, and left ventricular and right ventricular systolic function. LVAD implantation significantly improved ratio of TR color jet area/right atrial area as well as left ventricular and right ventricular systolic function and tethering distance (all P<0.05), whereas it enlarged TV annulus diameter (P=0.002). Significant residual TR was observed in 30 (23.6%) patients. Age, preoperative TV annulus diameter, and residual mitral regurgitation were significantly associated with significant residual TR (all P<0.05), whereas TV tethering was not. During a mean follow‐up of 21±17 months, patients with residual TR had significantly higher mortality than those without residual TR (log‐rank P<0.001).ConclusionsSignificant residual TR was observed in ≈25% patients supported with LVAD over 1 year and was associated with unfavorable outcome.

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Impact of tricuspid regurgitation on survival in patients with chronic heart failure: unexpected findings of a long-term observational study

Abstract: The prognostic impact of TR depends on the severity of CHF. While TR was significantly related with excess mortality in mild to moderate CHF, it provided no additive value in advanced disease when compared with established risk factors.

Cited by 157 publications

References 27 publications

Tricuspid Regurgitation Is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction

Tricuspid Regurgitation Is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction

Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation

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

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