Valvular Heart Disease
Risk Factors for Progression of Functional Tricuspid Regurgitation

https://doi.org/10.1016/j.amjcard.2013.11.055Get rights and content

The aim of this study was to determine the risk factors for tricuspid regurgitation (TR) progression in a contemporary population of patients referred for echocardiography. In a case-control study, we compared 100 consecutive patients with TR progression on serial echocardiograms (trivial or mild TR on the first echocardiogram and moderate or severe functional TR on a follow-up echocardiogram) with 100 patients matched for age and gender, having mild TR at baseline and no TR progression. Mean age was 72 ± 10 years, 55% were males, and time to TR progression was 5.3 ± 2.9 years. Less than 10% had rheumatic heart disease. Left ventricular ejection fraction was preserved (≥50%) in 85% of the TR progression group and in 74% of the control group (p = 0.06). Pulmonary artery systolic pressure increased from 41 ± 16 to 56 ± 18 mm Hg in the TR progression group and decreased from 44 ± 13 to 41 ± 11 mm Hg in the control group (p <0.0001). Independent risk factors for TR progression were pulmonary artery systolic pressure change during follow-up (odds ratio per 1 mm Hg 1.14, 95% confidence interval 1.06 to 1.23, p <0.0001), permanent atrial fibrillation (odds ratio 14.3, 95% confidence interval 4.6 to 44.2, p <0.0001), and coronary artery disease (odds ratio 5.7, 95% confidence interval 1.4 to 22.8, p = 0.015). All-cause mortality at 3 years was 20% for patients without TR progression, 42% for moderate TR, and 63% for severe TR, p <0.0001. Progression-to-severe TR independently predicted subsequent mortality. In conclusion, in patients with low prevalence of rheumatic heart disease and preserved left ventricular ejection fraction, pulmonary artery systolic pressure increase and permanent atrial fibrillation were the most powerful risk factors for TR progression. Progression-to-severe TR was an independent predictor of subsequent mortality.

Section snippets

Methods

This case-control study was based on the Lady Davis Carmel Medical Center echocardiography laboratory database. The echocardiography laboratory serves both inpatients and outpatients and functions both as a tertiary center and as a community service.

The study group comprised 100 consecutive patients who had TR progression on serial echocardiograms performed from January 2000 to December 2012. All patients had either trivial or mild TR on echo 1 (defined as the first available echocardiogram)

Results

Clinical characteristics of the patients with TR progression (n = 100) and the patients in the control group, who did not have TR progression (n = 100), are listed in Table 1. The 2 groups were well matched for age and gender. The TR progression group was slightly older, but although the difference was statistically significant, it was negligible (<1%). RHD was uncommon in both groups (<10%). Left-sided valvular heart disease was present in about a third of the patients, and less than 10% had

Discussion

In this study, we determined the risk factors for TR progression in patients referred for echocardiography in our echocardiography laboratory. Our patient population was different from previous studies, which included mostly young rheumatic patients after MV surgery.7, 8, 10 Our patients were on average 20 years older compared with previous studies, most of them were nonrheumatic and without previous MV surgery, and the majority without left-sided valvular heart disease and with preserved LVEF.

Disclosures

The authors have no conflicts of interest to disclose.

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