The first study to use cardiovascular magnetic resonance (CMR) to assess independent prognostic implications of functional tricuspid regurgitation (TR) found that both TR fraction (TRF) and TR volume (TRVol) were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction, according to a study published Sept. 7 in the Journal of the American College of Cardiology.

Yang Zhan, MD, FACC, et al., sought to examine the relationship between TRVol and TRF with all-cause mortality in 547 patients with functional TR. Researchers used CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. The study used natural history outcome data to derive thresholds for mild, moderate and severe TR.

Results of the study showed that during a median follow-up of 2.6 years, there were 93 deaths with an estimated five-year survival of 79%. Both TRF and TRVol were associated with mortality after adjustment of clinical and imaging variables, including right ventricle (RV) function.

"A TRVol of ≥45 ml or TRF of ≥50% had the greatest risk for excess mortality under medical management, with an [adjusted hazard ratio] of 2.3 and 2.6 compared with a TRVol of <30 ml of TRF of <30%, respectively," write the authors of the study.

"Future randomized controlled trials using these thresholds will determine if tricuspid valve intervention may benefit this high-risk group."

"This study provides the best evidence to date that severe TR has an independent effect on outcome and highlights the advantages of the accurate assessment of both the TR and RV function," writes Saul G. Myerson, MB CHB, MD, in an accompanying editorial comment.

"This may facilitate better identification of patients most likely to benefit from percutaneous tricuspid valve intervention. However, the benefit of treatment with percutaneous devices will needs confirmation in randomized clinical trials – even the best statistical techniques cannot completely remove the confounding effects of RV dilation and dysfunction."

Keywords: Tricuspid Valve Insufficiency, Tricuspid Valve, Stroke Volume, Prognosis, Heart Ventricles, Ventricular Function, Right, Dilatation, Pathologic, Proportional Hazards Models, Magnetic Resonance Spectroscopy

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