Prevalence, clinical characteristics and outcomes of heart failure patients with or without isolated or combined mitral and tricuspid regurgitation: An analysis from the ESC‐HFA Heart Failure Long‐Term Registry

Abstract

AimMitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum.Methods and resultsThe ESC‐HFA EORP HF Long‐Term Registry is a prospective, multicentre, observational study including patients with HF and 1‐year follow‐up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60–0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41–0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36–0.49), and combined MR/TR (OR 0.59; 95% 0.50–0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61–2.33). All‐cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR.ConclusionIn a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome.

Tricuspid regurgitation: Frequency, clinical presentation, management and outcome among patients with severe left‐sided valvular heart disease in Europe. Insights from the ESC‐EORP Valvular Heart Disease II survey

“…18 Tricuspid regurgitation is a serious condition and a predictive factor of outcome with a poorer outcome related to its grade. [6][7][8] Previous studies had shown that presence of severe TR before treatment of left-sided VHD was a predictor of poor outcome for both patients with aortic stenosis 3 and MR, 11,18,19 regardless of the treatment strategy (surgery or transcatheter) for left-sided VHD. This study is the first to show a parallel between the severity of the TR grade and overall mortality in the setting of all severe left-sided VHD, which is a very common situation as it represents approximately half of patients with TR.…”

Epidemiology, pathophysiology, diagnosis and management of chronic right‐sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

“…17 Moderate or severe TR has a prevalence of about 3-6% in the general population, 18,19 but is much higher in patients with left-sided valve disease, and especially with HF (both HFrEF and HFpEF), ranging between 10% and 23%. 3,8,[20][21][22] In patients with HF, TR is associated with increased mortality and HF hospitalization. [23][24][25] This prognostic impact increases with increasing TR severity 3,20,26,27 and is independent of RVD, pulmonary hypertension, concomitant mitral regurgitation, LV dysfunction, and AF.…”

“…Systemic congestion, involving splanchnic organs, is the first pathophysiological consequence of both RHF and TR. 22,24 Moreover, at the later stages, decrease in cardiac output leads to cerebral and peripheral hypoperfusion, and ventricular interdependence leads to pulmonary congestion 13,30 (Figure 2). A graphical description of the clinical course and presentation of RHF and TR is shown in Figure 3.…”

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

“…The concept of RA myopathy is increasingly recognized and may explain why a significant proportion of isolated TR patients (up to 38% in the European Society of Cardiology - Heart Failure Association, Heart Failure Long-Term Registry) do not have any history of AF. 1 , 39 , 40 Recent data showed that RA mechanics together with minimal RA size may be more relevant than maximal RA volume for the A-STR pathophysiology. Right atrial function, in terms of reservoir strain and haemodynamics, is more altered in A-STR patients compared with other TR aetiologies and in massive–torrential compared with severe TR.…”