Clinical presentation and outcome of tricuspid regurgitation in patients with systolic dysfunction. (27th July 2018)

• Record Type: Journal Article
• Authors: Topilsky, Yan; Inojosa, Jose Medina; Benfari, Giovanni; Vaturi, Ori; Maltais, Simon; Michelena, Hector; Mankad, Sunil; Enriquez-Sarano, Maurice
• Is Part Of: European heart journal. Volume 39:Number 39(2018)
• Page Start: 3584
• Page End: 3592
• Publication Date: 2018-07-27
• Subjects: Tricuspid regurgitation -- Systolic dysfunction -- Effective regurgitant orifice; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehy434
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: The impact of tricuspid regurgitation (TR) in patients with left ventricular systolic dysfunction on presentation and clinical outcome is uncertain due to confounding comorbidities and mediocre regurgitation ascertainment. Methods and results: In a cohort of patients with left ventricular systolic dysfunction (ejection fraction, EF < 50%) and functional TR (assessed quantitatively), we matched TR grade-groups for age, sex, EF, and TR velocity. Association of quantified TR (effective regurgitant orifice, ERO, severe if ≥0.4 cm 2 ) to clinical presentation and outcome was analysed. In the 291 cohort patients (age 70 ± 12 years) with left ventricular dysfunction (EF 31 ± 10%), functional TR ERO was 0.26 ± 0.3 cm 2 . Presentation with right heart failure was strongly related to TR quantified severity [adjusted odds ratios were 4.15 (1.95–8.84), P = 0.0002 for moderate TR and 6.86 (3.34–14.1), P < 0.0001 for severe TR]. Effective regurgitant orifice ≥0.4 cm 2 was associated with increased mortality [hazard ratio 1.6 (1.17–2.2), P = 0.003] unadjusted and after comprehensive adjustment [hazard ratio 1.8 (1.16–2.8), P = 0.009]. Furthermore, ERO ≥0.4 cm 2 was associated with increased cardiac events (mortality, new atrial fibrillation or heart failure) unadjusted [hazard ratio 1.9 (1.3–2.7), P = 0.002] and after comprehensive adjustment [hazard ratio 2.2 (1.1–4.6), P = 0.02]. Conclusion: Tricuspid regurgitation, even moderate, is associated at diagnosis with more severe heart failure presentation. While moderate TR is associated with heart failure at presentation, our quantitative data show that the threshold associated with reduced survival and more cardiac events is ERO ≥0.4 cm 2 . These data emphasize the clinical impact of functional TR and warrant large cohort-analysis and clinical trials of treatment of TR associated with left ventricular dysfunction.