Available online 6 December 2023

Author links open overlay panel, , , , , , , , , , , , AbstractBackground

Tricuspid regurgitation (TR) is associated with an increased mortality. Previous studies have analyzed predictors of TR progression and the clinical impact of baseline TR. However, there is a lack of evidence regarding the natural history of TR: the pattern of change and clinical impact of progression.

Objectives

The authors sought to evaluate predictors of TR progression and assess the prognostic impact of TR progression.

Methods

A total of 1,843 patients with at least moderate TR 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.

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% 1 year, 2 years, and 3 years, respectively. Older age (HR: 1.03), lower body mass index (HR: 0.95), chronic kidney disease (HR: 1.55), worse 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 ventricle ejection fraction (P < 0.001). TR progression was associated with an increased cardiovascular mortality and hospitalizations for heart failure (P < 0.001).

Conclusions

Marked individual variability in TR progression hindered accurate follow-up. In addition, TR progression was a determinant for survival regardless of initial TR severity.

Section snippetsStudy design and study population

An observational prospective study was designed. From October 1 until December 31, 2018, consecutive patients with at least moderate TR diagnosed by echocardiography in 9 participant hospitals were included in the study. Patients <18 years and those with prior tricuspid intervention, active endocarditis, or congenital heart disease with tricuspid valve involvement were excluded. A total of 1,843 patients were prospectively followed up with consecutive echocardiographic studies and clinical

Patient characteristics

Table 1 shows characteristics of the 1,442 patients, overall and stratified by grade of TR and progression. The mean age was 76.9 years (SD: 11.3), and 66% were women. Baseline moderate TR was present in 995 patients (69.0%), severe in 381 (26.4%), massive in 57 (4.0%), and torrential in 9 (0.6%).

Quantitative measurements of TR at baseline and follow-up to ensure an accurate assessment of TR progression were available in 953 patients (66.1%). The median time to follow-up echocardiography was

Discussion

This study, to the best of our knowledge, is the first to report characteristics, predictors, and rates of TR progression as well as outcomes in a large cohort of patients with significant TR having medium-term follow-up. Moreover, our study has the advantage of being a large, prospective, multicentric cohort, which is unprecedented in previous research. Previous retrospective studies assessed TR severity at a specific point in time and analyzed its evolution retrospectively. However, unlike

Conclusions

Patients with moderate TR had 4.9%, 10.1%, and 24.8% 1-year, 2-year, and 3-year risks of progression to severe TR, respectively. Our data provide evidence supporting serial echocardiographic testing for these patients. As an entire cohort, there was no significant TR progression over a 2-year period with marked individual variations, with TR progression in 19% of patients, relative stability in 43%, and TR reduction in 38%. Older age, lower body mass index, CKD, AF, worse NYHA functional class,

Funding Support and Author Disclosures

This study was supported by the Instituto de Salud Carlos III, PI20/01206. Dr Sitges has received consulting and lecture fees from General Electric, Canon Medical, Medtronic, Edwards Lifesciences, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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© 2023 by the American College of Cardiology Foundation. Published by Elsevier.