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Development of Significant Tricuspid Regurgitation
Study Questions:
What are the risk factors and prognostic implications of rapidly developing significant tricuspid regurgitation (TR)?
Methods:
This retrospective study examined 1,000 patients with significant (at least moderate) TR and a prior echocardiogram with no or mild TR, and evaluated risk factors for development of rapid significant TR as well as the prognostic significance of this. Patients were stratified into quartiles of time for development of significant TR (≤1.2, 1.3-4.7, 4.8-8.9, and ≥9.0 years).
Results:
The etiology of significant TR was primary and secondary TR in 6% and 94% of individuals, respectively. Variables independently associated with rapid significant TR included increased age (odds ratio [OR], 1.02), presence of a lead across the valve (OR, 1.59), baseline mild versus no TR (OR, 8.96), tricuspid annular plane excursion (OR, 0.86), dilated tricuspid annulus (OR, 1.06), and interval left-sided valve procedure (OR, 1.58). After identification of significant TR (median follow-up, 2.9 years), 42% of patients died. Rapid observation of significant TR was associated with higher adjusted mortality (HR per year to develop: 0.92; p < 0.001).
Conclusions:
Risk factors can identify patients at increased risk of rapidly developing significant TR. More rapid development of significant TR is associated with increased mortality.
Perspective:
This large retrospective study identifies risk factors for relatively rapid development of at least moderate TR and observes that more rapid development of significant TR is associated with increased mortality. These findings can help identify patients who may need closer follow-up and who may be at increased risk of mortality. It may also be helpful in determining when to perform tricuspid valve annuloplasty during surgery for left-sided valves given that this procedure was itself a risk factor for rapid development of significant TR. This study is limited by its retrospective nature and the performance of echocardiograms based on clinical indications.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Cardiac Surgical Procedures, Diagnostic Imaging, Echocardiography, Heart Valve Diseases, Mitral Valve, Prognosis, Risk Factors, Secondary Prevention, Tricuspid Valve, Tricuspid Valve Insufficiency
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