New insights of tricuspid regurgitation: a large-scale prospective cohort study

Abstract

Aims To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR. Methods and results Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III–IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk. Conclusion Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.

Multimodality Imaging of the Anatomy of Tricuspid Valve

“…Finally, in both above-mentioned studies, the most frequent cause of TR was functional. The prevalence of functional TR over the organic (or primary) TR has been recently confirmed by Vieitez et al [ 9 ]. In their prospective study of patients with significant TR, the authors found that primary TR was present in 7.4% of patients, whereas functional TR was present in 92.6%.…”

Beyond the Wires: A Case of Leadless Pacemaker–Mediated Tricuspid Regurgitation

“… 1 , 2 , 3 , 4 , 5 Contemporary studies show that PPMs and implantable cardioverter-defibrillators (ICDs) can cause a nonnegligible rate of significant TR (greater than or equal to moderate) in up to 5% of overall cases, with an evident increase in heart failure hospitalization and mortality rates. 6 , 7 , 8 , 11 These devices can affect TV function by one or more mechanisms, including perforation or impingement of one or more leaflets, lead entanglement into the subvalvular apparatus, RV dyssynchrony, and cardiac device–related endocarditis with associated direct infectious damage to the valvular structure or leaflet flail/avulsion after lead extraction ( Table 1 ). While LPs theoretically avoid multiple of these potential device-mediated TR causes, the pacemaker interaction with the complex TV subvalvular apparatus remains.…”

“…Cardiac device–induced TR is common and is associated with incremental morbidity and mortality. 6 , 7 , 8 The primary interventional approach in these situations is lead extraction followed by alternative modalities of pacing, including the leadless pacemaker (LP) systems. Leadless pacemakers were shown to be a safe and effective alternative pacing mode, with a growing acceptance and utilization in the medical community.…”

Transcatheter Tricuspid Valve-in-Valve Procedure—An Illustrative Case Report and Review

“…Assessing the severity of TR by echocardiography remains challenging and controversial. Although the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines considers three stages of FTR (mild, moderate, and severe) [28], the need has been felt for a more sensitive grading system [29]. A vena contracta ≥ 0.7 cm, effective regurgitant orifice area (EROA) of ≥0.40 cm 2 , and regurgitant volume ≥ 45 mL, qualify it as severe; however, no distinction is made after these particular parameters.…”

“…Thus, a more sensitive five-stage TR severity assessment (mild, moderate, severe, massive, and torrential) has recently been proposed aiming to further assist the optimal therapy choice [31]. Massive and torrential TR gradings may have implications regarding selecting of patients eligible for percutaneous treatment [29]. Nevertheless, this new grading system is not yet present in the guidelines of the main international societies.…”