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Prevalence and predictive factors for clinical outcomes of isolated functional tricuspid regurgitation

Published:January 03, 2023DOI:https://doi.org/10.1016/j.jjcc.2022.12.008

      Highlights

      • We evaluated prognosis of a large number of patients with severe tricuspid regurgitation (TR) (N = 1001).
      • A considerable number of patients (22 %) had isolated functional TR.
      • Renal function and anemia are prognostic predictors of isolated functional TR.

      Abstract

      Background

      A substantial number of patients have functional tricuspid regurgitation (TR).
      Isolated functional TR has been undertreated and may be a next target for transcatheter intervention. However, the prevalence, patient characteristics, and predictive factors for prognosis remain unclear.

      Methods

      From patients in our echocardiographic database (N = 64,242), we extracted those with severe TR and examined prognosis according to etiologies of TR. Thereafter, we focused on two types of isolated functional TR; progressive TR after left-sided valve surgery (postoperative TR) and TR associated with annular dilatation (atrial TR). Composite adverse events were defined as all-cause death or hospitalization for heart failure (HF).

      Results

      Of 1001 patients with severe TR (median age, 77 years; female, 58 %), 71 (7 %) patients were classified as postoperative TR, and 149 (15 %) as atrial TR. During the follow-up period (median, 1.6 years), 30 composite adverse events were observed (postoperative TR, n = 14; atrial TR, n = 16). Composite adverse events were less frequent in these two types of functional TR than TR of other etiologies. Multivariate analysis adjusted for age and sex showed that a history of hospitalization for HF, history of cardiac surgery >2 times, loop diuretics, estimated glomerular filtration rate, blood urea nitrogen, hemoglobin, platelet level, left ventricular ejection fraction, and right ventricular dimension were associated with clinical adverse events (p < 0.05), while B-type natriuretic peptide level was not.

      Conclusions

      A considerable number of patients had isolated functional TR. Extracardiac factors such as renal function, hemoglobin and platelet are important in determining clinical outcomes.

      Graphical abstract

      Keywords

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