Novel risk model for one-year mortality and guidance of management strategy in isolated severe secondary tricuspid regurgitation. (14th October 2021)

• Record Type: Journal Article
• Authors: Wang, T K M; Mentias, A; Akyuz, K; Kirincich, J; Duran Crane, A; Pettersson, G B; Gillinov, A M; Popovic, Z B; Xu, B; Griffin, B P; Desai, M Y
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Tricuspid Valve Disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.1700
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Isolated severe tricuspid regurgitation (TR) is a challenging valve lesion to manage because of adverse prognosis, and surgery remains controversial especially in secondary etiologies. We aimed to devise a risk model to predict one-year mortality in isolated secondary TR patients, and evaluated whether risk category influenced the association between tricuspid valve surgery and survival. Methods: Consecutive patients with isolated severe secondary TR by echocardiography during 2004–2018 were retrospectively studied. A multivariable model was developed for one-year all-cause mortality from two thirds of study patients (randomly-selected derivation cohort), and then assessed in the remaining patients (validation cohort). Associations between tricuspid valve surgery and survival were analyzed overall and in risk categories in multivariable analyses. Results: Amongst 8575 isolated TR patients with secondary etiologies, mean age was 71.3±14.5 years and 5153 (60.1%) were female. Tricuspid valve surgery was performed in 487 (5.7%) patients, and was independently associated with improved survival during follow-up with hazards ratio 0.57 (95% confidence interval 0.41–0.81) in multivariable analysis. One-year mortality occurred in 2108 (24.6%) patients, and an additive risk score out of 14 based on independent predictors of one-year mortality is shown in the Table 1. The c-statistic for the derivation cohort was 0.712, and for the validation cohort 0.729. By risk score category, one-year mortality was 5.7% for 0–1 (low), 10.1% for 2–3 (mildly elevated), 24.3% for 4–7 (moderately elevated) and 50.9% for >7 (severely elevated), as shown in Figure 1. Surgery was associated with improved survival in the three higher score categories of isolated TR patients (P<0.001 to P=0.037), but did not improve survival in lower risk patients with scores of 0–1 (P=0.140). Conclusion: We devised and validated a novel risk model which moderately discriminated one-year mortality for isolated severe secondary TR. The score may help guide decision-making for management strategy in those with elevated scores, when the under-utilized tricuspid valve surgery is associated with improved survival, and further research is necessary to apply this score for those considering for transcatheter therapies. Funding Acknowledgement: Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand