Mid-term outcome of severe tricuspid regurgitation: are there any differences according to mechanism and severity?

Abstract

Aims Patients with significant tricuspid regurgitation (TR) addressed according the new classification in torrential TR may have different prognosis compared with just severe TR patients. We sought to determine distribution and mechanism of consecutive severe TR patients, in accordance with aetiology and severity by applying the new proposed classification scheme and their long-term outcomes. Methods and results Between January and December 2013, 249 patients with significant TR referred to the cardiac imaging unit (mean age 79.9 ± 10.2 years; 29.8% female) were included. Patients were divided according to aetiology in six groups, and TR severity was reclassified into severe, massive, and torrential TR. The follow-up period was of 313 ± 103 days. When considering cardiovascular mortality, patients in the massive/torrential group showed the highest number of events (P < 0.007). Patients with TR due to pulmonary diseases had the worst prognosis according to different aetiology. Noteworthy, the best predictors for the combined endpoint [cardiovascular mortality and readmission admission for heart failure (HF)] were TR severity according to the new classification [hazard ratio (HR) 2.48, 95% confidence interval (CI) 1.25–4.93] and clinical scores such as New York Heart Association classification and congestive status (HR 1.78, 95% CI 1.28–2.49; HR 2.08, 95% CI 1.06–4.06, respectively). Conclusion Patients with massive/torrential TR and patients with comorbidities, especially pulmonary disease, were identified as populations at higher risk of death and readmission for HF. New classification scheme and clinical assessment may establish who may benefit the most of intensive therapeutic treatments and intervention on the tricuspid valve.

PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of tricuspid regurgitation: a propensity-matched analysis

“…For Triluminate-the prospective single-arm multicenter trial for the TriClip System (NT size)-a TR reduction by ≥ 1 grade was obtained in 91% of patients [9]. In both the Triluminate trial and our analysis, a five-class grading scheme was used to assess the severity of TR [12], as massive or torrential TR, which are included in the five-class grading, are associated with a higher risk of death and readmission of HF [20]. Braun and Fam et al did not report TR reduction at discharge, but indicated a TR reduction to grade 2 + or lower in 85% of PASCAL cases and 69% for XTR patients.…”

Atrial functional tricuspid regurgitation: a novel and underappreciated clinical entity

“…Therefore, in advanced stages with massive or torrential FTR, marked remodeling of TV apparatus, and secondary RA and RV dysfunction due to longstanding volume overload, it may be more challenging to distinguish the primary cause of FTR 6,16 . However, the prognosis of massive/torrential FTR is severe 30,31 and there is likely little clinical benefi t in clarifying the pathophysiological sequence at this advanced stage of the disease. Figure 3 presents the main imaging features that may help in differentiating the atrial FTR from the ventricular FTR.…”

State-of-the-Art Review: Anatomical and Imaging Considerations During Transcatheter Tricuspid Valve Repair Using an Annuloplasty Approach

“…Although this extended scale is not evidence-based, it may be useful to help better characterize the effect of transcatheter intervention on the TR grade. In addition, natural history studies show, that the prognosis of patients with "very severe" TR is significantly worse compared to patients with "severe" TR, thus suggesting, that any reduction of TR may result in improved outcomes and a reduction of mortality (36). However, long-term outcomes related to reduction in TR after transcatheter procedures are not currently available.…”