Characteristics and treatment strategies for severe tricuspid regurgitation

Brenden S. Ingraham, Sorin V. Pislaru, Vuyisile T Nkomo, Rick A. Nishimura, John M. Stulak, Joseph A. Dearani, Charanjit Rihal, Mackram Eleid

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: This study aimed to identify characteristics, spectrum of tricuspid regurgitation (TR) severity and treatment patterns in patients considered for intervention of severe TR at a tertiary centre. The population being considered for TR intervention is currently not well defined and the role of transcatheter interventions is unclear. Methods: The study involved 87 patients with severe TR considered for intervention from 1 March 2016 to 12 November 2018 at Mayo Clinic. Patients receiving medications alone were compared with those receiving intervention to identify patterns in demographics, clinical/echocardiographic associations and survival. Results: Mean age was 80±9 (56% female), 93% had atrial fibrillation and 64% had chronic kidney disease ≥3 a. Follow-up was 331±276 days; 95% were symptomatic with 6 min walk distance of 270±110 m. Loop diuretics were used in 93%; aldosterone antagonists in 35%. Mean tricuspid annular plane systolic excursion was 15.6±3.8 mm, effective regurgitant orifice area (EROA) 82±32 mm 2 and stroke volume index 39±11 mL/m 2 ; 48% had at least moderate right ventricular (RV) dysfunction, and 75% did not undergo intervention. Patients receiving intervention showed trends towards larger EROA (93±33 vs 75±31 mm 2 ), better right ventricular function and more severe symptoms. Overall group 30-day and 1-year survival were 100% and 76%, respectively. Conclusions: Patients with severe TR considered for intervention are commonly elderly with atrial fibrillation, advanced TR and RV dysfunction; 75% were treated with medications alone and not offered intervention. Patients with greater EROA, better RV function and more severe symptoms were more likely to receive intervention. These findings have implications for future trial design.

Original languageEnglish (US)
JournalHeart
DOIs
StatePublished - Jan 1 2019

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Tricuspid Valve Insufficiency
Right Ventricular Dysfunction
Right Ventricular Function
Atrial Fibrillation
Therapeutics
Mineralocorticoid Receptor Antagonists
Sodium Potassium Chloride Symporter Inhibitors
Survival
Chronic Renal Insufficiency
Stroke Volume
Demography
Population

Keywords

  • device
  • minimally invasive
  • transcatheter intervention
  • tricuspid regurgitation
  • TVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Characteristics and treatment strategies for severe tricuspid regurgitation. / Ingraham, Brenden S.; Pislaru, Sorin V.; Nkomo, Vuyisile T; Nishimura, Rick A.; Stulak, John M.; Dearani, Joseph A.; Rihal, Charanjit; Eleid, Mackram.

In: Heart, 01.01.2019.

Research output: Contribution to journalArticle

Ingraham, Brenden S. ; Pislaru, Sorin V. ; Nkomo, Vuyisile T ; Nishimura, Rick A. ; Stulak, John M. ; Dearani, Joseph A. ; Rihal, Charanjit ; Eleid, Mackram. / Characteristics and treatment strategies for severe tricuspid regurgitation. In: Heart. 2019.
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abstract = "Objective: This study aimed to identify characteristics, spectrum of tricuspid regurgitation (TR) severity and treatment patterns in patients considered for intervention of severe TR at a tertiary centre. The population being considered for TR intervention is currently not well defined and the role of transcatheter interventions is unclear. Methods: The study involved 87 patients with severe TR considered for intervention from 1 March 2016 to 12 November 2018 at Mayo Clinic. Patients receiving medications alone were compared with those receiving intervention to identify patterns in demographics, clinical/echocardiographic associations and survival. Results: Mean age was 80±9 (56{\%} female), 93{\%} had atrial fibrillation and 64{\%} had chronic kidney disease ≥3 a. Follow-up was 331±276 days; 95{\%} were symptomatic with 6 min walk distance of 270±110 m. Loop diuretics were used in 93{\%}; aldosterone antagonists in 35{\%}. Mean tricuspid annular plane systolic excursion was 15.6±3.8 mm, effective regurgitant orifice area (EROA) 82±32 mm 2 and stroke volume index 39±11 mL/m 2 ; 48{\%} had at least moderate right ventricular (RV) dysfunction, and 75{\%} did not undergo intervention. Patients receiving intervention showed trends towards larger EROA (93±33 vs 75±31 mm 2 ), better right ventricular function and more severe symptoms. Overall group 30-day and 1-year survival were 100{\%} and 76{\%}, respectively. Conclusions: Patients with severe TR considered for intervention are commonly elderly with atrial fibrillation, advanced TR and RV dysfunction; 75{\%} were treated with medications alone and not offered intervention. Patients with greater EROA, better RV function and more severe symptoms were more likely to receive intervention. These findings have implications for future trial design.",
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