Prevalence, Burden and Echocardiographic Features of Moderate to Severe Tricuspid Regurgitation: Insights from a Tertiary Referral Center

posted on 30.01.2019 by Claudio Montalto, Antonio Mangieri, Richard J. Jabbour, Matteo Pagnesi, Nicola Buzzatti, Pierpasquale Leone, Damiano Regazzoli, Francesco Ancona, Giuseppe Lanzillo, Francesco Giannini, Stefano Stella, Michele De Bonis, Ottavio Alfieri, Paolo G. Camici, Alberto Margonato, Antonio Colombo, Eustachio Agricola, Azeem Latib

Background: Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center.

Methods: A retrospective analysis was performed on 6309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE).

Results: A total of 2336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III–IV (p = 0.022) and on higher doses of loop diuretic (p = 0.022) than those with only moderate TR. Multivariable analysis revealed that blood urea nitrogen (BUN, p = 0.031) and abnormal liver function blood tests (p = 0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and tricuspid annular plane systolic excursion were found to be independent predictors of mid-term NACE.

Conclusions: The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.