Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up

Abstract

Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was 5 years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N = 40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7 ± 9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3 ± 6.45 [%], LA area 46.4 ± 8.06 (mm2), LV internal diastolic diameter (LVIDD) 59.6 ± 3.94 (mm), RV fractional area change 22.3 ± 4.36 (%), systolic pulmonary artery pressure (SPAP) 48.4 ± 9.45 (mmHg). Independent variables associated with FTR development were age ≥ 65y [OR 1.2], failed revascularization, LA area ≥ 42.5 (mm2) [OR 17.1], LVEF ≤ 24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p = 0.06 and p = 0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.

Association Between Functional Tricuspid Regurgitation and Mortality Following Cardiac Surgery

“…Previous studies have reported an association between TR and adverse outcomes after cardiac surgery. 1 , 3 , 18 , 19 These studies were focused on narrow patient groups undergoing either mitral or aortic valve interventions. A seminal publication by Sagie 20 studied 318 patients undergoing percutaneous balloon mitral valvuloplasty for mitral stenosis and found TR to be among the most important predictors of procedural outcomes and 4-year mortality.…”

Perspective Chapter: Right Ventricular Free Wall – The Forgotten Territory for Revascularization

“…During follow-up, functional TR continues to progress in 97.5% of the patients with newly developed functional TR after the index event. The functional TR progression rate was highest in patients with moderate to severe RV dysfunction, > moderate MR, pulmonary hypertension, and LV dysfunction [34].…”

“…In another longitudinal analysis study, but after percutaneous coronary intervention (PCI), Koren et al followed the evolution of functional TR in 134 patients presented with ischemic MR after myocardial infarction for a median follow-up of 5 years [34]. They excluded all other etiologies of TR such as primary tricuspid valve pathology, pulmonary hypertension, or RV leads.…”

Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?

“…In specific, there is a close relation of TR with other valvular pathologies, as studies show that TR coexists with severe mitral regurgitation in 30–50% of patients and with severe aortic stenosis in 25% of patients [ 26 ]. Additionally, ischemic mitral regurgitation is strongly associated with development and progression of TR, while TR severity is proportional to the extent of the regurgitation [ 27 ]. Furthermore, studies showed that coexistence of TR at the time of surgery for mitral or aortic regurgitation adversely affects short- and long-term outcomes [ 28 , 29 ].…”