Prevalence of significant tricuspid regurgitation in patients with successful percutaneous mitral valvuloplasty for mitral stenosis: results from 12 years' follow-up of one centre prospective registry
- Seung-Pyo Lee1,2,
- Hyung-Kwan Kim1,2,
- Kyung-Hee Kim1,2,
- Ji-Hyun Kim1,
- Hyo Eun Park2,3,
- Yong-Jin Kim1,2,
- Goo-Yeong Cho2,4,
- Dae-Won Sohn1,2
- 1Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 3Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
- 4Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Correspondence to Professor Hyung-Kwan Kim, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Korea; hkkim73{at}snu.ac.kr
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Contributors S-PL, K-HK, and H-KK contributed to the study design, collected data and performed the analysis. H-KK, J-HK, HEP, Y-JK, G-YC and D-WS recruited patients and interpreted the data. S-PL and H-KK wrote the manuscript. Y-JK and D-WS contributed to this work with valuable opinions and comments. H-KK works as guarantor of the article. All authors read and approved the final manuscript.
- Accepted 14 August 2012
- Published Online First 9 September 2012
Abstract
Background Percutaneous mitral valvuloplasty (PMV) is an attractive therapeutic option for mitral stenosis (MS).
Objective To investigate the incidence and development of tricuspid regurgitation (TR) long after successful PMV.
Design, patients and interventions A prospective cohort of 299 patients with symptomatic MS who underwent successful PMV as first-line treatment between 1988 and 2010.
Setting One tertiary university hospital.
Main outcome measures Significant TR, defined as a grade ≥3 on echocardiographic analysis.
Results Although most TR regressed in these patients immediately after the procedure, 56 patients developed significant TR during follow-up (median 12 years, IQR 8.0–18.0 years). The cumulative incidence of significant TR increased time-dependently (9.4%, 19.8% and 35.2% at 8, 12 and 18 years of follow-up, respectively). Atrial fibrillation (AF) and TR grade ≥2 before PMV were found to be independent predictors of significant TR (HR (95% CI) 3.049 (1.169 to 7.949) and 3.016 (1.303 to 6.982), p=0.023 and 0.010 for pre-PMV AF and pre-PMV TR grade ≥2, respectively). Even after, exclusion of patients with significant TR at baseline, pre-PMV TR grade ≥2 and AF remained important factors of de novo TR development. Mitral valve restenosis was also associated with late significant TR development.
Conclusions Significant TR after successful PMV in patients with MS is not uncommon long after PMV. TR development is closely associated with mitral valve restenosis. More attention should be paid during long-term follow-up to TR development in patients with MS who have significant pre-PMV TR and/or AF.
- Atrial fibrillation
- mitral stenosis
- percutaneous procedures
- tricuspid regurgitation
- valvuloplasty
- heart failure
- cardiac function
- imaging and diagnostics
- echocardiography
- valvular disease
- MRI
- arrhythmias
- diastolic dysfunction
- tricuspid valve disease
- echocardiography-exercise
- stress testing
- cardiac imaging
- valvular heart disease
Footnotes
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Funding This research was partly supported by the leading foreign research institute recruitment programme through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (MEST) (0640-20100001).
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Competing interests None.
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Ethics approval Ethics approval was provided by the institutional review board of Seoul National University Hospital.
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Provenance and peer review Not commissioned; externally peer reviewed.
