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Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem.

Abstract：

OBJECTIVE:To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival. PATIENTS AND METHODS:We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50%, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality. RESULTS:Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6% (204) were women, atrial fibrillation was present in 74.0% (214), and 24.6% (71) had an intracardiac device. By 5 years after diagnosis, 51.5% had been hospitalized for heart failure. Observed 5-year mortality was 47.8% compared with 36.3% in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95% CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95% CI, 1.16-2.8; P=.009) as associated with increased mortality. CONCLUSION:Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Fender EA,Petrescu I,Ionescu F,Zack CJ,Pislaru SV,Nkomo VT,Cochuyt JJ,Hodge DO,Nishimura RA

doi

10.1016/j.mayocp.2019.04.036

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

2032-2039

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(19)30467-7

journal_volume

pub_type

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Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem.