Prognostic validation of partition values for quantitative parameters to grade functional tricuspid regurgitation severity by conventional echocardiography

Abstract

Aims Quantitative echocardiography parameters are seldom used to grade tricuspid regurgitation (TR) severity due to relative paucity of validation studies and lack of prognostic data. To assess the relationship between TR severity and the composite endpoint of death and hospitalization for congestive heart failure (CHF); and to identify the threshold values of vena contracta width (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFr) to define low, intermediate, and high-risk TR based on patients’ outcome data. Methods and results A cohort of 296 patients with at least mild TR underwent 2D, 3D, and Doppler echocardiography. We built statistical models (adjusted for age, NYHA class, left ventricular ejection fraction, and pulmonary artery systolic pressure) for VCavg, EROA, RegVol, and RegFr to study their relationships with the hazard of outcome. The tertiles of the derived hazard values defined the threshold values of the quantitative parameters for TR severity grading. During 47-month follow-up, 32 deaths and 72 CHF occurred. Event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild TR, respectively. Severe TR was graded as VCavg > 6 mm, EROA > 0.30 cm2, RegVol > 30 mL, and RegF > 45%. Conclusion This outcome study demonstrates the prognostic value of quantitative parameters of TR severity and provides prognostically meaningful threshold values to grade TR severity in low, intermediate, and high risk.

Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper

“…Although a mild degree of TR is frequent and benign, moderate and severe TR are associated with poor prognosis. 98,99 It should be stressed that TR is most often seen in patients with multiple valvular disease, especially aortic or MV disease.…”

Transcatheter treatment for tricuspid valve disease

“…Accumulating evidence links EROA to outcome in various settings 22,23 and current American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines define severe TR as an EROA ≥0.40 cm 2 and RVol ≥45 mL 20,24 . However, since patients undergoing transcatheter TV interventions (TTVI) frequently have an anatomical regurgitant area several times greater than an EROA of 0.40 cm 2 , an extended classification to include "massive" and "torrential" TR (both associated with detrimental outcomes) has recently been proposed (Supplementary Table 1) [23][24][25][26][27] .…”

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

“…Some studies demonstrated that FTR severity was associated with worse outcome. During 47-month follow-up, Muraru et al showed that event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild FTR, respectively [ 2 ]. Event was defined as death or occurrence of heart failure.…”

“…In the last decade, our knowledge about TV anatomy, morphology, and function significantly increased due to enormous development of imaging techniques and primarily three-dimensional echocardiography (3DE) [1]. At the same time, growing data of evidence revealed the importance of functional tricuspid regurgitation (FTR) on the outcome in patients with different cardiovascular diseases (CVD) including concomitant valvular disease (aortic stenosis, mitral regurgitation), heart failure, pulmonary hypertension, and even in patients without evident CVD [2][3][4][5]. Figure 1 illustrates difference in etiologies that lead to primary (organic) and secondary (functional) tricuspid regurgitation.…”