Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem

Fender, Erin A.; Petrescu, Ioana; Ionescu, Filip; Zack, Chad J.; Pislaru, Sorin V.; Nkomo, Vuyisile T.; Cochuyt, Jordan J.; Hodge, David O.; Nishimura, Rick A.

doi:10.1016/j.mayocp.2019.04.036

Cited by 42 publications

(21 citation statements)

References 27 publications

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“…21 The mechanism is likely to be multifactorial and include factors such as bilateral atrial enlargement, 22 tricuspid annulus dilatation, 23 tricuspid valve deformation, and right heart remodelling. 24 Our finding concurs with a previous study in patients with LVEF > 50% that demonstrated a similarly high prevalence of AF (74%) in patients with isolated TR, 25 while only approximately half the patients with HFrEF had concomitant AF (48%). 2 The discrepancy can be partly explained by patients with HFrEF being more often accompanied by an enlarged right ventricular chamber, which results in tricuspid annulus dilatation.…”

supporting

confidence: 89%

The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction

Ren

Fang

et al. 2020

ESC Heart Failure

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Aims Previous studies have demonstrated that moderate/severe tricuspid regurgitation (TR) is associated with adverse outcome in patients with heart failure (HF) with reduced ejection fraction. Little is known about the prevalence and prognostic value of TR in patients of stage B HF and those with stage C HF with preserved ejection fraction (HFpEF). We aimed to investigate the prevalence and prognosis of TR in patients with HFpEF. Methods and results From 2013 to 2017, 2014 patients with stage B (n = 1341) or C (n = 673) HFpEF were enrolled in the study. Detailed transthoracic echocardiogram was performed, and the severity of TR was graded as no, mild, moderate, and severe. The mean age of the study population was 66.7 ± 14.1 years old, and 46% were men. Mean left ventricular ejection fraction was 62.2 ± 5.5%. The prevalence of moderate/severe TR increased from stage B to C HF (8% to 16%, respectively, P < 0.01). Older age, hyperlipidaemia, atrial fibrillation, left ventricular mass, and right ventricular systolic pressure were independently associated with moderate/severe TR (P < 0.05 for all). With a median follow-up of 3.8 (2.9-4.7) years, 346 patients died and 234 developed HF requiring hospitalization. Kaplan-Meier curve revealed that the presence of moderate/severe TR was associated with all-cause mortality, HF requiring hospitalization and cardiovascular death (log-rank test P < 0.01). Multivariable analysis demonstrated that moderate (hazard ratio = 1.5; 95% confidence interval: 1.1-2.2; P < 0.05) and severe TR (hazard ratio = 2.1; 95% confidence interval: 1.3-3.3; P < 0.01) were independently associated with mortality, HF requiring hospitalization and cardiovascular death. Conclusions The presence of moderate/severe TR is not uncommon in patients with stage B HF and stage C HFpEF. Importantly, moderate/severe TR was independently associated with mortality and HF requiring hospitalization.

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supporting

confidence: 89%

The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction

Ren

Fang

et al. 2020

ESC Heart Failure

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“…Surgery for isolated TV disease is rarely performed: in a state-wide analysis of 289 patients diagnosed with moderate to severe or severe TR, only 3.8% of the study population underwent tricuspid operation during the 10-year study period. 147 An analysis of the National Inpatient Sample, which represents ≈20% of all US hospital admissions, identified between 290 and 780 operations per year in the United States between 2004 and 2013. 148 In this analysis in-hospital mortality after tricuspid surgery was 8.8%, repair was associated with better survival and there was no significant difference in outcomes between men and women, who represented the majority of patients undergoing tricuspid surgery (58%; Table 2).…”

Section: Tricuspid Valve Disordersmentioning

confidence: 99%

“…In a state-based analysis of 289 patients diagnosed with moderate to severe or severe TR, 5-year mortality was significantly higher (47.8%) compared with an age- and sex-matched population (36.3%, P =0.005). 147 Women with TR have more rapid progression from milder disease to moderate and severe disease (Table 2). 122 Sex-specific data on procedural outcomes in TR are limited, and sex-based differences have not been well-documented.…”

Section: Tricuspid Valve Disordersmentioning

confidence: 99%

Sex Differences and Similarities in Valvular Heart Disease

DesJardin

Chikwe

Hahn

et al. 2022

Circulation Research

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As populations age worldwide, the burden of valvular heart disease has grown exponentially, and so has the proportion of affected women. Although rheumatic valve disease is declining in high-income countries, degenerative age-related causes are rising. Calcific aortic stenosis and degenerative mitral regurgitation affect a significant proportion of elderly women, particularly those with comorbidities. Women with valvular heart disease have been underrepresented in many of the landmark studies which form the basis for guideline recommendations. As a consequence, surgical referrals in women have often been delayed, with worse postoperative outcomes compared with men. As described in this review, a more recent effort to include women in research studies and clinical trials has increased our knowledge about sex-based differences in epidemiology, pathophysiology, diagnostic criteria, treatment options, outcomes, and prognosis.

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“…However, there is no consensus on other potential predictors, including the presence of right HF, pulmonary hypertension, increased atrial volume, atrial fibrillation (AFib), rheumatic mitral valve disease, marked RV remodelling/dysfunction or a history of ischaemic heart disease. [14][15][16] There is wide agreement on the therapeutic response to severe TR, but the approach to lesser grades remains controversial. Thus, American clinical practice guidelines 17 centre on severe or progressive TR, while European guidelines 18 include recommendations for lower grades associated with certain predictors of residual TR.…”

Section: What This Study Addsmentioning

confidence: 99%

Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation

et al. 2022

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IntroductionRecurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1 year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables.MethodsA prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3 months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to-severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early/late mortality and residual TR were evaluated.ResultsTR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1 year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to-significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality.ConclusionsSevere residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery.

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Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem

Cited by 42 publications

References 27 publications

The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction

The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction

Sex Differences and Similarities in Valvular Heart Disease

Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation

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