Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting

Topilsky, Yan; Maltais, Simon; Medina‐Inojosa, José R.; Oğuz, Didem; Michelena, Héctor I.; Maalouf, Joseph F.; Mahoney, Douglas W.; Enríquez-Sarano, Maurice

doi:10.1016/j.jcmg.2018.06.014

Cited by 558 publications

(384 citation statements)

References 26 publications

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“…Our population prevalence of 1.6% was similar to the 2.7% community prevalence in people aged >65 reported in the UK OxVALVE study,20 although lower than the 5% prevalence in an analysis of 79 043 patients performed by a private community echocardiography service 21. In another recent community-based study by Topilsky et al , the age and sex-adjusted prevalence of moderate or severe TR was reported as 0.55% 22. Interestingly, large community-based studies of valve disease prevalence in the USA and Norway23 24 addressed only left-sided VHD and did not report the prevalence of TR, which our results suggest may have limited their ability to predict outcome.…”

Section: Discussionsupporting

confidence: 85%

“…Furthermore, several studies have demonstrated that TV annuloplasty during surgery for left-sided VHD is associated with improved outcome 26–28. Hence, data from the present study as well as previous studies support the practice of performing a TV annuloplasty in all patients having left-sided valvular procedures with anything more than mild TR, especially if the annulus is dilated 21 22…”

Section: Discussionsupporting

confidence: 82%

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Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

et al. 2019

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ObjectivesThe true prevalence and disease burden of moderate or severe (significant) tricuspid regurgitation (TR) in patients undergoing routine echocardiography remains unknown. Our aim was to explore the prevalence of significant TR and the impact of pulmonary hypertension (PH) on outcome in a less selected cohort of patients referred to echocardiography.MethodsFrom 12 791 echocardiograms performed between January and December 2010, a total of 209 (1.6%) patients (72±14 years, 56% men) were identified with significant TR; 123 (0.96%) with moderate and 86 (0.67%) with severe TR. Median follow-up time was 80 months (mean 70±33 months). Systolic pulmonary artery pressure was derived from peak velocity of tricuspid regurgitant jet plus the right atrial pressure and considered elevated if ≥40 mm Hg (PH).ResultsDuring follow-up there were 123 (59%) deaths with no difference in mortality between moderate and severe TR (p=0.456). The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p<0.001). PH was associated with lower event-free survival in moderate (log-rank, p<0.001), but not in severe TR (log-rank, p=0.133). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S′, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95% CI 1.41 to 3.47, p=0.001).ConclusionsModerate or severe TR was found in 1.6% of patients attending for routine echocardiograms. PH identified a high-risk subset of patients with moderate TR but not with severe TR.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 82%

Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

et al. 2019

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“…Functional tricuspid regurgitation (TR), a frequent contributor to right‐sided heart failure, is a highly prevalent, age‐dependent condition and carries an increased independent risk of cardiovascular mortality . Surgical tricuspid valve (TV) repair or replacement in moderate and severe symptomatic functional TR is indicated as a concomitant procedure to left‐sided valve surgery, and in markedly symptomatic patients in the absence of right or left ventricular dysfunction or severe pulmonary hypertension .…”

Section: Introductionmentioning

confidence: 99%

Aetiology‐based clinical scenarios predict outcomes of transcatheter edge‐to‐edge tricuspid valve repair of functional tricuspid regurgitation

Schlotter

Orban

Rommel

et al. 2019

European J of Heart Fail

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Aims Transcatheter tricuspid valve repair (TTVR) is an emerging technique to treat tricuspid regurgitation (TR). Predictors of adverse outcomes are scarce, and stratification by TR aetiologies is lacking. Methods and results We report the bi‐centre procedural outcomes of 164 patients undergoing TTVR for TR stratified into four aetiology‐based clinical scenarios (CSs). By stepwise categorization, patients were categorized into Dialysis‐CS if they were on chronic haemodialysis; patients not undergoing dialysis with MR grade ≥ 3 into MR‐CS; patients not meeting the inclusion into Dialysis‐CS or MR‐CS with an invasively‐determined systolic pulmonary artery pressure ≥ 50 mmHg into PAPs‐CS; and the remaining patients into Afib‐CS in case a history of atrial fibrillation/flutter existed. Clinical characteristics and procedural outcomes were evaluated. Procedural success was > 80% in all CSs and decreased mortality (P = 0.03). Within the group of patients with procedural success, PAPs‐CS had the highest rates of the primary endpoint of death, heart failure hospitalization or reintervention (P = 0.01). Mortality was significantly higher in PAPs‐CS when compared to the other CSs (P = 0.03) and Dialysis‐CS had the highest mortality rate (33.3%). In all CSs, the majority of patients experienced New York Heart Association functional class improvement at follow‐up. Conclusions Stratification of TTVR into aetiology‐based CSs may open new paths to stratify for clinical risk and procedural benefit and may aid in the design of clinical trials in the heterogeneous TTVR patient population. Despite the observed CS outcome differences, TTVR appears feasible and safe, and confers functional improvements in patients with TR and heart failure.

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“…With the growing incidence of atrial fibrillation, 16 the use of intracardiac devices, 17 and the global epidemic of valvular heart disease, the prevalence of TR is likely to increase. 18 Recently, Topilsky et al 19 reported the prevalence of TR (0.55%) in a community setting which was about one-fourth of all left-sided valve disease and similar to the prevalence of aortic stenosis. The distribution pattern of TR was primary in 14.6% and secondary in 85.4% of patients.…”

Section: Pathophysiology Of Tricuspid Regurgitation and Rationale Formentioning

confidence: 86%

“…The distribution pattern of TR was primary in 14.6% and secondary in 85.4% of patients. 19 Primary TR results from primary abnormalities of the TV apparatus and can be divided into congenital and acquired disease. The latter may include rheumatic disease, carcinoid disease, infective endocarditis, degenerative, or iatrogenic disease from implantable device lead-induced TV injury/dysfunction or RV endomyocardial biopsy.…”

Section: Pathophysiology Of Tricuspid Regurgitation and Rationale Formentioning

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

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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.

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Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting

Abstract: Clinically significant (greater or equal to moderate) TR is common in community residents diagnosed by Doppler echocardiography and increases with age. Isolated TR is associated with excess mortality, thus TR represents an important public health problem.

Cited by 558 publications

References 26 publications

Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

Aetiology‐based clinical scenarios predict outcomes of transcatheter edge‐to‐edge tricuspid valve repair of functional tricuspid regurgitation

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

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