Long‐Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation

Abstract

Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long‐term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left‐sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all‐cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow‐up period of 26.5 (interquartile range, 6.0–57.9) months. The 5‐year event‐free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01–1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01–1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002–1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36–0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m 2 ) revealed a graded increase in the risk of adverse events ( P <0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.

Which lesions are not amenable to tricuspid clipping?

“…Severe tricuspid regurgitation is independently associated with mortality [1,2], heart failure, and poor quality of life [3]. Although diuretics remain the cornerstone of medical management of severe tricuspid regurgitation [4], tricuspid transcatheter edge-toedge repair (T-TEER) has emerged as a promising alternative; given the high mortality associated with isolated tricuspid surgery [5].…”

Deep Learning Phenotyping of Tricuspid Regurgitation for Automated High Throughput Assessment of Transthoracic Echocardiography

“…Introduction Accurate and reliable assessment of tricuspid regurgitation (TR) severity remains an ongoing challenge. Once considered a benign consequence of co-existing heart disease, tricuspid regurgitation has received more recent recognition as an independent risk factor for morbidity and mortality [1][2][3] . While recent findings highlight the need for earlier diagnosis and monitoring, early TR rarely presents with symptoms in the absence of co-existing cardiac disease.…”