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

Abstract

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.

Sex Differences in Right Ventricular Systolic Function and All-Cause Mortality in Tricuspid Regurgitation

“…Other studies have similarly demonstrated a consistent relationship with TR and sex [3-5]. Although mild TR is generally considered to be associated with a benign prognosis, moderate and severe TR is associated with right ventricular (RV) dysfunction and comparable mortality rates if left untreated [6]. With evidence also suggesting that women represent an independent risk factor for poor perioperative outcomes [7, 8], it is surprising that there continues to remain a lack of scientific data in the literature about sex differences in TR, and whether aside from prevalence, sex influences RV performance, pulmonary hypertension, and clinical outcomes.…”