Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis

Wang, Nelson; Fulcher, Jordan; Abeysuriya, Nishan; McGrady, Michele; Wilcox, Ian; Celermajer, David S.; Lal, Sean

doi:10.1093/eurheartj/ehy641

Cited by 232 publications

(157 citation statements)

References 37 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…In HFpEF, TR is a strong predictor of death and rehospitalizations [13,25] and increases as RVD progresses over time [26]. In a recent meta-analysis including >30,000 patients with significant TR in different cardiac scenarios, TR was associated with an increased mortality risk independent of RV failure or PH [27]. On the other hand, when a significant functional TR is present, patients with RV failure (but no RV enlargement) have worse clinical outcomes [28].…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Santas

Espriella

Chorro

et al. 2020

JCM

View full text Add to dashboard Cite

Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP ≥ 0.36 without significant TR; stage 2: TAPSE/PASP ≥ 0.36 with significant TR; stage 3: TAPSE/PASP < 0.36 without significant TR; and stage 4: TAPSE/PASP < 0.36 with significant TR. By the 1 year follow-up, 207 (23.4%) patients had died. We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001). After multivariable adjustment, and compared to stage 1, stages 3 and 4 were independently associated with mortality risk (HR: 1.8219; 95% CI 1.308–2.538; p < 0.001 and HR = 2.2632; 95% CI 1.540–3.325; p < 0.001, respectively). A RVD staging system, integrating TAPSE/PASP and TR, provides a comprehensive and widely available tool for risk stratification in HFpEF.

show abstract

Section: Discussionmentioning

confidence: 99%

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Santas

Espriella

Chorro

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…It is associated with impaired prognosis in heart failure with preserved as well as reduced ejection fraction [2,3]. An increasing body of evidence also relates moderate/severe TR to an increased mortality risk, which is independent of pulmonary pressures or right ventricular (RV) function [4,5].…”

Section: Introductionmentioning

confidence: 99%

Interventional treatment of tricuspid regurgitation

Goliasch

Mascherbauer

2020

Wien Klin Wochenschr

View full text Add to dashboard Cite

“…2,3 A recent meta-analysis demonstrated that moderate/severe TR is associated with a two-fold increased mortality risk compared with no/mild TR, which seems to be independent of pulmonary pressures and right heart failure (HF). 4 Topilsky et al 5 reported that quantitative measures of TR were associated with increased mortality in patients with left ventricular (LV) Tricuspid regurgitation remains undertreated as a result of our limited understanding of the disease and how to quantify it. [6][7][8] Surgery is currently the only Class I Guideline Recommended therapy for TR, 9,10 which is most often performed during left-sided heart surgery.…”

Section: Introductionmentioning

confidence: 99%

Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review

Chang

Veen

Hahn

et al. 2019

European Heart Journal

View full text Add to dashboard Cite

Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.

show abstract

Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis

Cited by 232 publications

References 37 publications

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Interventional treatment of tricuspid regurgitation

Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review

Contact Info

Product

Resources

About