Tricuspid regurgitation and long-term clinical outcomes

• Published in: European heart journal cardiovascular imaging Vol. 21; no. 2; pp. 157 - 165
• Main Authors: Chorin, Ehud, Rozenbaum, Zach, Topilsky, Yan, Konigstein, Maayan, Ziv-Baran, Tomer, Richert, Eyal, Keren, Gad, Banai, Shmuel
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2020
• Subjects: tricuspid regurgitation; prognosis; echocardiography
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jez216

Abstract
Aims
Tricuspid regurgitation (TR) is a frequent echocardiographic finding; however, its effect on outcome is unclear. The objectives of current study were to evaluate the impact of TR severity on heart failure hospitalization and mortality.
Methods and results
We retrospectively reviewed consecutive echocardiograms performed between 2011 and 2016 at the Tel-Aviv Medical Center. TR severity was determined using semi-quantitative approach including colour jet area, vena contracta width, density of continuous Doppler jet, hepatic vein flow pattern, trans-tricuspid inflow pattern, annular diameter, right ventricle, and right atrial size. Major comorbidities, re-admissions and all-cause mortality were extracted from the electronic health records. The final analysis included 33 305 patients with median follow-up period of 3.34 years (interquartile range 2.11–4.54). TR (≥mild) was present in 31% of our cohort. One-year mortality rates were 7.7% for patients with no/trivial TR, 16.8% for patients with mild TR, 29.5% for moderate TR, and 45.6% for patients with severe TR (P < 0.001). Univariate and multivariate analyses demonstrated a positive correlation between TR severity and overall mortality and rates of heart failure re-admission after adjustment for potential confounders. The proportional hazards method for overall mortality showed that patients with moderate [hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.02–1.3, P = 0.024] and severe TR (HR 1.43, 95% CI 1.08–1.88, P = 0.011) had a worse prognosis than those with no or minimal TR.
Conclusions
The presence of any degree of TR is associated with adverse clinical outcome. At least moderate TR is independently associated with increased mortality.