Tricuspid regurgitation and long-term clinical outcomes

Abstract

AimsTricuspid regurgitation (TR) is a frequent echocardiographic finding; however, its effect on outcome is unclear. The objectives of current study were to evaluate the impact of TR severity on heart failure hospitalization and mortality.Methods and resultsWe retrospectively reviewed consecutive echocardiograms performed between 2011 and 2016 at the Tel-Aviv Medical Center. TR severity was determined using semi-quantitative approach including colour jet area, vena contracta width, density of continuous Doppler jet, hepatic vein flow pattern, trans-tricuspid inflow pattern, annular diameter, right ventricle, and right atrial size. Major comorbidities, re-admissions and all-cause mortality were extracted from the electronic health records. The final analysis included 33 305 patients with median follow-up period of 3.34 years (interquartile range 2.11–4.54). TR (≥mild) was present in 31% of our cohort. One-year mortality rates were 7.7% for patients with no/trivial TR, 16.8% for patients with mild TR, 29.5% for moderate TR, and 45.6% for patients with severe TR (P < 0.001). Univariate and multivariate analyses demonstrated a positive correlation between TR severity and overall mortality and rates of heart failure re-admission after adjustment for potential confounders. The proportional hazards method for overall mortality showed that patients with moderate [hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.02–1.3, P = 0.024] and severe TR (HR 1.43, 95% CI 1.08–1.88, P = 0.011) had a worse prognosis than those with no or minimal TR.ConclusionsThe presence of any degree of TR is associated with adverse clinical outcome. At least moderate TR is independently associated with increased mortality.

An analysis of the cost-effectiveness of transcatheter mitral valve repair for people with secondary mitral valve regurgitation in the UK

“…This is known as functional mitral (MR) or tricuspid (TR) regurgitation. Both conditions adversely affect outcomes and healthcare utilisation in CHF [1,2,3,4,5,6,7,8,9,10,11].…”

The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction

“…One of the merits of the present study is the detailed follow-up where the exact cause of mortality was acknowledged unlike other studies. [2][3][4] Our results highlight that moderate/severe TR is associated with cardiovascular mortality but is neutral for non-cardiovascular mortality. Also confirming that the mechanism of TR-related mortality is driven by cardiovascular complications, the present study further recommends that clinicians should focus on prevention of cardiovascular outcome when significant TR is detected in those at risk of HF or with HFpEF.…”

“…Likewise, an incidental finding of moderate and severe TR can be found in 7% in community setting and 12% in hospitalized patients with heart failure (HF) 2–4 . The clinical relevance of TR has been further demonstrated in studies showing that significant TR is strongly associated with adverse outcome in various populations 2–4 . Consequently, an increasing number of studies are focusing on evaluation of the natural progression and outcome of TR.…”

“…The presence of trivial and mild tricuspid regurgitation (TR) is often detected during transthoracic echocardiography assessment and has long been thought to be clinically benign 1 . Likewise, an incidental finding of moderate and severe TR can be found in 7% in community setting and 12% in hospitalized patients with heart failure (HF) 2–4 . The clinical relevance of TR has been further demonstrated in studies showing that significant TR is strongly associated with adverse outcome in various populations 2–4 .…”

Interventionelle Therapien zur Behandlung der hochgradigen Trikuspidalklappeninsuffizienz

“…Eine Dilatation des Klappenannulus im anterior-posterioren Ringbereich ist die Folge [4]. Unabhängig von der Ätiologie der Erkrankung sowie von Alter, Geschlecht oder Komorbiditäten konnte eine Assoziation zwischen einer höhergradigen Insuffizienz und einer erhöhten Mortalität nachgewiesen werden [5]. Die medikamentöse Therapie, die vor allem die Gabe von Diuretika beinhaltet, stellt einen symptomatischen Therapieansatz dar, der allerdings nicht mit einer Verbesserung der Mortalität einhergeht [1].…”