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. 2023 Jan 3;12(1):e025751.
doi: 10.1161/JAHA.122.025751. Epub 2022 Dec 24.

Long-Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation

Naoki Nishiura  1 , Takeshi Kitai  1   2 , Taiji Okada  1 , Madoka Sano  1 , Norihisa Miyawaki  1 , Kitae Kim  1 , Ryosuke Murai  1 , Toshiaki Toyota  1 , Yasuhiro Sasaki  1 , Natsuhiko Ehara  1 , Atsushi Kobori  1 , Makoto Kinoshita  1 , Tadaaki Koyama  3 , Yutaka Furukawa  1
Affiliations

Long-Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation

Naoki Nishiura et al. J Am Heart Assoc. .

Abstract

Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long-term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left-sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all-cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow-up period of 26.5 (interquartile range, 6.0-57.9) months. The 5-year event-free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01-1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002-1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36-0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m2) revealed a graded increase in the risk of adverse events (P<0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.

Keywords: heart failure; prognosis; surgery; tricuspid regurgitation; valvular heart disease.

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Figures

Figure 1
Figure 1. Kaplan‐Meier survival curves for a composite of all‐cause death and hospitalization for heart failure (HF).
Figure 2
Figure 2. Incidence of adverse events (A) and Kaplan‐Meier survival curves for all‐cause death and hospitalization for HF (B), stratified by the number of risk factors.
Alb indicates albumin; BUN, blood urea nitrogen; HF, heart failure; LAVi, left atrial volume index; and TRPG, tricuspid regurgitation pressure gradient.
Figure 3
Figure 3. Kaplan‐Meier survival curves for all‐cause death among all study patients (A) and those stratified by the number of risk factors (B).
Figure 4
Figure 4. Diagram of association between advanced TR and multiorgan damages.
LA indicates left atrial; LV, left ventricular; and TR, tricuspid regurgitation.
See this image and copyright information in PMC

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