Natural course of tricuspid regurgitation and prognostic implications

Objective Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.Methods In this observatio...

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Main Authors: Maki Okamoto, Christian Butter, Karin Bramlage, Marwin Bannehr, Christoph Roland Edlinger, Ulrike Kahn, Josephin Liebchen, Valentin Hähnel, Victoria Dworok, Fabian Schipmann, Tanja Kücken, Anja Haase-Fielitz
Format: Article
Language:English
Published: BMJ Publishing Group 2021-06-01
Series:Open Heart
Online Access:https://openheart.bmj.com/content/8/1/e001529.full
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spelling doaj-1f1a8d7a1b91435198dbddba7525142f2021-07-28T18:00:35ZengBMJ Publishing GroupOpen Heart2053-36242021-06-018110.1136/openhrt-2020-001529Natural course of tricuspid regurgitation and prognostic implicationsMaki Okamoto0Christian Butter1Karin Bramlage2Marwin Bannehr3Christoph Roland Edlinger4Ulrike Kahn5Josephin Liebchen6Valentin Hähnel7Victoria Dworok8Fabian Schipmann9Tanja Kücken10Anja Haase-Fielitz11Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyInstitute for Pharmacology and Preventive Medicine, Cloppenburg, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyCardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, GermanyObjective Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.Methods In this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.Results At baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).Conclusion While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.https://openheart.bmj.com/content/8/1/e001529.full
collection DOAJ
language English
format Article
sources DOAJ
author Maki Okamoto
Christian Butter
Karin Bramlage
Marwin Bannehr
Christoph Roland Edlinger
Ulrike Kahn
Josephin Liebchen
Valentin Hähnel
Victoria Dworok
Fabian Schipmann
Tanja Kücken
Anja Haase-Fielitz
spellingShingle Maki Okamoto
Christian Butter
Karin Bramlage
Marwin Bannehr
Christoph Roland Edlinger
Ulrike Kahn
Josephin Liebchen
Valentin Hähnel
Victoria Dworok
Fabian Schipmann
Tanja Kücken
Anja Haase-Fielitz
Natural course of tricuspid regurgitation and prognostic implications
Open Heart
author_facet Maki Okamoto
Christian Butter
Karin Bramlage
Marwin Bannehr
Christoph Roland Edlinger
Ulrike Kahn
Josephin Liebchen
Valentin Hähnel
Victoria Dworok
Fabian Schipmann
Tanja Kücken
Anja Haase-Fielitz
author_sort Maki Okamoto
title Natural course of tricuspid regurgitation and prognostic implications
title_short Natural course of tricuspid regurgitation and prognostic implications
title_full Natural course of tricuspid regurgitation and prognostic implications
title_fullStr Natural course of tricuspid regurgitation and prognostic implications
title_full_unstemmed Natural course of tricuspid regurgitation and prognostic implications
title_sort natural course of tricuspid regurgitation and prognostic implications
publisher BMJ Publishing Group
series Open Heart
issn 2053-3624
publishDate 2021-06-01
description Objective Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.Methods In this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.Results At baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).Conclusion While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.
url https://openheart.bmj.com/content/8/1/e001529.full
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