Natural course of tricuspid regurgitation and prognostic implications

Abstract

ObjectiveFunctional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.MethodsIn this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.ResultsAt baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).ConclusionWhile TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.

Transvenous ICD Implantation into a Coronary Sinus Branch: A Safe and Feasible Alternative to Deliver ICD after Tricuspid Valve Reconstruction

“…Moderate-to-severe TR is associated with increased mortality irrespectively of biventricular systolic function and pulmonary pressure. In addition, chronic RV pacing may deteriorate RV function, causing pacing-induced cardiomyopathy, and further annulus dilatation [ 7 ]. The reported mean survival from diagnosis of severe TR is 4.35 years, with further reduced survival of 2.28 years after the onset of symptoms [ 8 ].…”

Tricuspid regurgitation, the last challenge left

“…Several clinical conditions such as ischemic heart disease, cardiomyopathy, pacemaker leads, chronic obstructive pulmonary disease, and AF are well‐known as causes of functional TR 4 . The severity of TR is graded as none/trivial, mild, moderate, and severe, and its severity is associated with the patient's life expectancy, with the 5‐year survival rate for severe TR being reduced to 20% 5 . It is also known that patients with TR progression have a worse prognosis than those without.…”

“…4 The severity of TR is graded as none/trivial, mild, moderate, and severe, and its severity is associated with the patient's life expectancy, with the 5-year survival rate for severe TR being reduced to 20%. 5 It is also known that patients with TR progression have a worse prognosis than those without. Among the etiologies of TR, AF is extremely important as a particular condition that cardiologists can directly intervene and resolve.…”

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

“…Advances in three-dimensional (3D) echocardiography imaging, including machine learning algorithms, provide a more reliable and feasible examination of the right ventricle without geometrical assumptions [1,11]. Furthermore, the pathophysiology of RV function is often related to tricuspid regurgitation (TR) [12,13]. A mild degree of TR is highly prevalent and is usually considered a benign incidental finding on routine echocardiography [12].…”