CLINICAL RESEARCH: VALVULAR HEART DISEASE
Impact of tricuspid regurgitation on long-term survival
Jayant Nath, MD*,*,
Elyse Foster, MD, FACC and
Paul A. Heidenreich, MD*
* Veterans Affairs Medical Center, Palo Alto, USA
University of California San Francisco, San Francisco, California, USA.
Manuscript received December 13, 2002;
revised manuscript received September 2, 2003,
accepted September 16, 2003.
* Reprint requests and correspondence: Dr. Jayant Nath, Veterans Affairs Medical Center, Department of Medicine, Division of Cardiology, 3801 Miranda Avenue, 111C, Palo Alto, California 94304, USA.
jayant{at}pol.net
jnath{at}cvmed.stanford.edu
OBJECTIVES: The goal of this study was to examine mortality associated with tricuspid regurgitation (TR) after controlling for left ventricular ejection fraction (LVEF), right ventricular (RV) dilation and dysfunction, and pulmonary artery systolic pressure (PASP).
BACKGROUND: Tricuspid regurgitation is a frequent echocardiographic finding; however, the association with prognosis is unclear.
METHODS: We retrospectively identified 5,223 patients (age 66.5 ± 12.8 years; predominantly male) undergoing echocardiography at one of three Veterans Affairs Medical Center laboratories over a period of four years. Follow-up data were available for four years (mean 498 ± 402 days). Kaplan-Meier and proportional hazards methods were used to compare differences in survival among TR grades.
RESULTS: Mortality increased with increasing severity of TR. The one-year survival was 91.7% with no TR, 90.3% with mild TR, 78.9% with moderate TR, and 63.9% with severe TR. Moderate or greater TR was associated with increased mortality regardless of PASP (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.16 to 1.49 for PASP >40 mm Hg; HR 1.32, 95% CI 1.05 to 1.62 for PASP  40 mm Hg) and LVEF (HR 1.49, 95% CI 1.34 to 1.66 for EF <50%; HR 1.54, 95% CI 1.37 to 1.71 for EF  50%). When adjusted for age, LVEF, inferior vena cava size, and RV size and function, survival was worse for patients with moderate (HR 1.17, 95% CI 0.96 to 1.42) and severe TR (HR 1.31, 95% CI 1.05 to 1.66) than for those with no TR.
CONCLUSIONS: We conclude that increasing TR severity is associated with worse survival in men regardless of LVEF or pulmonary artery pressure. Severe TR is associated with a poor prognosis, independent of age, biventricular systolic function, RV size, and dilation of the inferior vena cava.
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Abbreviations and Acronyms
| | HR | = hazard ratio | | IVC | = inferior vena cava | | LV | = left ventricle/ventricular | | LVEF | = left ventricular ejection fraction | | PASP | = pulmonary artery systolic pressure | | RV | = right ventricle/ventricular | | TR | = tricuspid regurgitation |
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