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

• Published in: Mayo Clinic proceedings Vol. 94; no. 10; pp. 2032 - 2039
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-10-2019; Frontline Medical Communications Inc; Elsevier Limited
• Subjects: Age; Aged; Aged, 80 and over; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cohort Studies; Congenital diseases; Female; Genetic disorders; Health aspects; Health care; Heart diseases; Heart failure; Heart valve diseases; Humans; Hypertension; Male; Medical prognosis; Medical records; Minnesota; Mortality; Prognosis; Pulmonary hypertension; Regurgitation; Retrospective Studies; Risk Factors; Stenosis; Surgery; Survival Rate; Task forces; Thoracic surgery; Tricuspid Valve Insufficiency - mortality; Minnesota; EF; TV; RV; AF; IVC; PH; HR; IQR; HF; TR; RA
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2019.04.036

To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival.
We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50%, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality.
Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6% (204) were women, atrial fibrillation was present in 74.0% (214), and 24.6% (71) had an intracardiac device. By 5 years after diagnosis, 51.5% had been hospitalized for heart failure. Observed 5-year mortality was 47.8% compared with 36.3% in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95% CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95% CI, 1.16-2.8; P=.009) as associated with increased mortality.
Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.