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Tricuspid Regurgitation Progression and Clinical Implications
Quick Takes
- The study showed that patients with significant tricuspid regurgitation (TR) had a high prevalence of comorbidities, and that TR progression was a determinant for survival regardless of TR initial severity.
- Serial echocardiographic testing in patients with moderate TR should be similar to that endorsed by current guidelines for left-sided heart disease.
- The early recognition of patients at risk of TR progression may identify patients that need close surveillance to provide appropriate therapy and reduce the impact of TR progression on outcomes.
Study Questions:
What are the predictors of tricuspid regurgitation (TR) progression and the prognostic impact of TR progression?
Methods:
The investigators identified a total of 1,843 patients with at least moderate TR and were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. All patients with less than a 2-year follow-up were excluded. Clinical and echocardiographic features, hospitalizations for heart failure, and cardiovascular death and interventions were recorded to assess their impact in TR progression. The cumulative event rates were estimated with the Kaplan-Meier method and compared by means of the log-rank test. Multivariable Cox analysis was performed with a forward selection modeling with a variable entry criterion of a value of p < 0.05 to determine predictors of TR progression and with the Fine-Gray competing risk regression model to assess independent associations with cardiovascular mortality and hospitalization for heart failure.
Results:
At a median 2.3-year follow-up, 19% of patients experienced progression. Patients with baseline moderate TR presented a rate progression of 4.9%, 10.1%, and 24.8% at 1 year, 2 years, and 3 years, respectively. Older age (hazard ratio [HR], 1.03), lower body mass index (HR, 0.95), chronic kidney disease (HR, 1.55), worse New York Heart Association (NYHA) functional class (HR, 1.52), and right ventricle dilation (HR, 1.33) were independently associated with TR progression. TR progression was associated with an increase in chamber dilation as well as a decrease in ventriculoarterial coupling and in left ventricular ejection fraction (p < 0.001). TR progression was associated with an increased cardiovascular mortality and hospitalizations for heart failure (p < 0.001).
Conclusions:
The authors report that TR progression was a determinant for survival regardless of initial TR severity.
Perspective:
This study reports that patients with significant TR had a high prevalence of comorbidities, and that TR progression was a determinant for survival regardless of TR initial severity. These data suggest that serial echocardiographic testing in patients with moderate TR should be similar to that endorsed by current guidelines for left-sided heart disease. Furthermore, the early recognition of patients at risk of TR progression may identify patients that need close surveillance to provide appropriate therapy and reduce the impact of TR progression on outcomes. Future studies are indicated to explore the use of transcatheter therapies for moderate TR aiming to prevent TR progression and possibly improve outcomes.
Clinical Topics: Noninvasive Imaging, Valvular Heart Disease, Echocardiography/Ultrasound
Keywords: Echocardiography, Heart Valve Diseases, Tricuspid Valve Insufficiency
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