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.
|
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 |
|
This article has been cited by other articles:
|
|
|
|
 
B.-C. Chang, S.-W. Song, S. Lee, K.-J. Yoo, M.-S. Kang, and N. Chung
Eight-Year Outcomes of Tricuspid Annuloplasty Using Autologous Pericardial Strip for Functional Tricuspid Regurgitation
Ann. Thorac. Surg.,
November 1, 2008;
86(5):
1485 - 1493.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. De Bonis, E. Lapenna, F. Sorrentino, G. La Canna, A. Grimaldi, F. Maisano, L. Torracca, and O. Alfieri
Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy
Eur. J. Cardiothorac. Surg.,
April 1, 2008;
33(4):
600 - 606.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena
Principles and Practice of Echocardiography in Cardiac Surgery
Card. Surg. Adult,
January 1, 2008;
3(2008):
315 - 348.
[Full Text]
|
|
|
|
|
|
|
H. Song, D.-H. Kang, J. H. Kim, K.-M. Park, J.-M. Song, K.-J. Choi, M.-K. Hong, C. H. Chung, J.-K. Song, J.-W. Lee, et al.
Percutaneous Mitral Valvuloplasty Versus Surgical Treatment in Mitral Stenosis With Severe Tricuspid Regurgitation
Circulation,
September 11, 2007;
116(11_suppl):
I-246 - I-250.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Ghanta, R. Chen, N. Narayanasamy, S. McGurk, S. Lipsitz, F. Y. Chen, and L. H. Cohn
Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: Midterm results of 237 consecutive patients
J. Thorac. Cardiovasc. Surg.,
January 1, 2007;
133(1):
117 - 126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K. Singh, G. H.L. Tang, M. D. Maganti, S. Armstrong, W. G. Williams, T. E. David, and M. A. Borger
Midterm Outcomes of Tricuspid Valve Repair Versus Replacement for Organic Tricuspid Disease
Ann. Thorac. Surg.,
November 1, 2006;
82(5):
1735 - 1741.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. F. Voelkel, R. A. Quaife, L. A. Leinwand, R. J. Barst, M. D. McGoon, D. R. Meldrum, J. Dupuis, C. S. Long, L. J. Rubin, F. W. Smart, et al.
Right Ventricular Function and Failure: Report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure
Circulation,
October 24, 2006;
114(17):
1883 - 1891.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T.-T. Ton-Nu, R. A. Levine, M. D. Handschumacher, D. J. Dorer, C. Yosefy, D. Fan, L. Hua, L. Jiang, and J. Hung
Geometric Determinants of Functional Tricuspid Regurgitation: Insights From 3-Dimensional Echocardiography
Circulation,
July 11, 2006;
114(2):
143 - 149.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. H. L. Tang, T. E. David, S. K. Singh, M. D. Maganti, S. Armstrong, and M. A. Borger
Tricuspid Valve Repair With an Annuloplasty Ring Results in Improved Long-Term Outcomes
Circulation,
July 4, 2006;
114(1_suppl):
I-577 - I-581.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fukuda, A. M. Gillinov, P. M. McCarthy, W. J. Stewart, J.-M. Song, T. Kihara, M. Daimon, M.-S. Shin, J. D. Thomas, and T. Shiota
Determinants of Recurrent or Residual Functional Tricuspid Regurgitation After Tricuspid Annuloplasty
Circulation,
July 4, 2006;
114(1_suppl):
I-582 - I-587.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Filsoufi, S. P. Salzberg, M. Coutu, and D. H. Adams
A Three-Dimensional Ring Annuloplasty for the Treatment of Tricuspid Regurgitation
Ann. Thorac. Surg.,
June 1, 2006;
81(6):
2273 - 2277.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-K. Kim, Y.-J. Kim, K.-I. Kim, S.-H. Jo, K.-B. Kim, H. Ahn, D.-W. Sohn, B.-H. Oh, M.-M. Lee, Y.-B. Park, et al.
Impact of the Maze Operation Combined With Left-Sided Valve Surgery on the Change in Tricuspid Regurgitation Over Time
Circulation,
August 30, 2005;
112(9_suppl):
I-14 - I-19.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
