Clinical outcome of isolated tricuspid regurgitation

Yan Topilsky, Vuyisile T Nkomo, Ori Vatury, Hector I Michelena, Thierry Letourneau, Rakesh M. Suri, Sorin Pislaru, Soon Park, Douglas W. Mahoney, Simon Biner, Maurice E Sarano

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: The aim of this study was to assess the outcome of isolated tricuspid regurgitation (TR) and the added value of quantitative evaluation of its severity. BACKGROUND: TR is of uncertain clinical outcome due to confounding comorbidities. Isolated TR (without significant comorbidities, structural valve disease, signi ficant pulmonary artery systolic pressure elevation by Doppler, or overt cardiac cause) is of unknown clinical outcome. METHODS: In patients with isolated TR assessed both qualitatively and quantitatively by a proximal isovelocity surface area method, a long-term outcome analysis was conducted. Patients with severe comorbid diseases were excluded. RESULTS: The study involved 353 patients with isolated TR (age 70 years; 33% male; ejection fraction, 63%; all with right ventricular systolic pressure <50 mm Hg). Severe isolated TR was diagnosed in 76 patients (21.5%) qualitatively and 68 patients (19.3%) by quantitative criteria (effective regurgitant orifice [ERO] ≥40 mm<sup>2</sup>). The 10-year survival and cardiac event rates were 63 ± 5% and 29 ± 5%. Severe isolated TR independently predicted higher mortality (adjusted hazard ratio: 1.78 [95% confidence interval (CI): 1.10 to 2.82], p = 0.02 for qualitative definition and 2.67 [95% CI:1.66 to 4.23] for an ERO ≥40 mm<sup>2</sup>, p < 0.0001). The addition of grading by quantitative criteria in nested models eliminated the significance of the qualitative grading and improved the model prediction (p < 0.001 for survival and p = 0.02 for cardiac events). The 10-year survival rate was lower with an ERO ≥40 mm<sup>2</sup> versus <40 mm<sup>2</sup> (38 ± 7% vs. 70 ± 6%; p < 0.0001), independent of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all), and lower than expected in the general population (p < 0.001). Freedom from cardiac events was lower with an ERO ≥40 mm<sup>2</sup> versus <40 mm<sup>2</sup> independently of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all). Cardiac surgery for severe isolated TR was rarely performed (16 ± 5% 5 years after diagnosis). CONCLUSIONS: Isolated TR can be severe and is associated with excess mortality and morbidity, warranting heightened attention to diagnosis and quantitation. Quantitative assessment of TR, particularly ERO measurement, is a powerful independent predictor of outcome, superior to standard qualitative assessment.

Original languageEnglish (US)
Pages (from-to)1185-1194
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume7
Issue number12
DOIs
StatePublished - 2014

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Tricuspid Valve Insufficiency
Comorbidity
Confidence Intervals
Blood Pressure
Mortality
Ventricular Pressure
Pulmonary Artery
Thoracic Surgery
Morbidity
Pressure
Lung
Survival

Keywords

  • Effective regurgitant orifice
  • Isolated tricuspid regurgitation
  • Prognosis
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Clinical outcome of isolated tricuspid regurgitation. / Topilsky, Yan; Nkomo, Vuyisile T; Vatury, Ori; Michelena, Hector I; Letourneau, Thierry; Suri, Rakesh M.; Pislaru, Sorin; Park, Soon; Mahoney, Douglas W.; Biner, Simon; Sarano, Maurice E.

In: JACC: Cardiovascular Imaging, Vol. 7, No. 12, 2014, p. 1185-1194.

Research output: Contribution to journalArticle

Topilsky, Y, Nkomo, VT, Vatury, O, Michelena, HI, Letourneau, T, Suri, RM, Pislaru, S, Park, S, Mahoney, DW, Biner, S & Sarano, ME 2014, 'Clinical outcome of isolated tricuspid regurgitation', JACC: Cardiovascular Imaging, vol. 7, no. 12, pp. 1185-1194. https://doi.org/10.1016/j.jcmg.2014.07.018
Topilsky, Yan ; Nkomo, Vuyisile T ; Vatury, Ori ; Michelena, Hector I ; Letourneau, Thierry ; Suri, Rakesh M. ; Pislaru, Sorin ; Park, Soon ; Mahoney, Douglas W. ; Biner, Simon ; Sarano, Maurice E. / Clinical outcome of isolated tricuspid regurgitation. In: JACC: Cardiovascular Imaging. 2014 ; Vol. 7, No. 12. pp. 1185-1194.
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T1 - Clinical outcome of isolated tricuspid regurgitation

AU - Topilsky, Yan

AU - Nkomo, Vuyisile T

AU - Vatury, Ori

AU - Michelena, Hector I

AU - Letourneau, Thierry

AU - Suri, Rakesh M.

AU - Pislaru, Sorin

AU - Park, Soon

AU - Mahoney, Douglas W.

AU - Biner, Simon

AU - Sarano, Maurice E

PY - 2014

Y1 - 2014

N2 - OBJECTIVES: The aim of this study was to assess the outcome of isolated tricuspid regurgitation (TR) and the added value of quantitative evaluation of its severity. BACKGROUND: TR is of uncertain clinical outcome due to confounding comorbidities. Isolated TR (without significant comorbidities, structural valve disease, signi ficant pulmonary artery systolic pressure elevation by Doppler, or overt cardiac cause) is of unknown clinical outcome. METHODS: In patients with isolated TR assessed both qualitatively and quantitatively by a proximal isovelocity surface area method, a long-term outcome analysis was conducted. Patients with severe comorbid diseases were excluded. RESULTS: The study involved 353 patients with isolated TR (age 70 years; 33% male; ejection fraction, 63%; all with right ventricular systolic pressure <50 mm Hg). Severe isolated TR was diagnosed in 76 patients (21.5%) qualitatively and 68 patients (19.3%) by quantitative criteria (effective regurgitant orifice [ERO] ≥40 mm2). The 10-year survival and cardiac event rates were 63 ± 5% and 29 ± 5%. Severe isolated TR independently predicted higher mortality (adjusted hazard ratio: 1.78 [95% confidence interval (CI): 1.10 to 2.82], p = 0.02 for qualitative definition and 2.67 [95% CI:1.66 to 4.23] for an ERO ≥40 mm2, p < 0.0001). The addition of grading by quantitative criteria in nested models eliminated the significance of the qualitative grading and improved the model prediction (p < 0.001 for survival and p = 0.02 for cardiac events). The 10-year survival rate was lower with an ERO ≥40 mm2 versus <40 mm2 (38 ± 7% vs. 70 ± 6%; p < 0.0001), independent of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all), and lower than expected in the general population (p < 0.001). Freedom from cardiac events was lower with an ERO ≥40 mm2 versus <40 mm2 independently of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all). Cardiac surgery for severe isolated TR was rarely performed (16 ± 5% 5 years after diagnosis). CONCLUSIONS: Isolated TR can be severe and is associated with excess mortality and morbidity, warranting heightened attention to diagnosis and quantitation. Quantitative assessment of TR, particularly ERO measurement, is a powerful independent predictor of outcome, superior to standard qualitative assessment.

AB - OBJECTIVES: The aim of this study was to assess the outcome of isolated tricuspid regurgitation (TR) and the added value of quantitative evaluation of its severity. BACKGROUND: TR is of uncertain clinical outcome due to confounding comorbidities. Isolated TR (without significant comorbidities, structural valve disease, signi ficant pulmonary artery systolic pressure elevation by Doppler, or overt cardiac cause) is of unknown clinical outcome. METHODS: In patients with isolated TR assessed both qualitatively and quantitatively by a proximal isovelocity surface area method, a long-term outcome analysis was conducted. Patients with severe comorbid diseases were excluded. RESULTS: The study involved 353 patients with isolated TR (age 70 years; 33% male; ejection fraction, 63%; all with right ventricular systolic pressure <50 mm Hg). Severe isolated TR was diagnosed in 76 patients (21.5%) qualitatively and 68 patients (19.3%) by quantitative criteria (effective regurgitant orifice [ERO] ≥40 mm2). The 10-year survival and cardiac event rates were 63 ± 5% and 29 ± 5%. Severe isolated TR independently predicted higher mortality (adjusted hazard ratio: 1.78 [95% confidence interval (CI): 1.10 to 2.82], p = 0.02 for qualitative definition and 2.67 [95% CI:1.66 to 4.23] for an ERO ≥40 mm2, p < 0.0001). The addition of grading by quantitative criteria in nested models eliminated the significance of the qualitative grading and improved the model prediction (p < 0.001 for survival and p = 0.02 for cardiac events). The 10-year survival rate was lower with an ERO ≥40 mm2 versus <40 mm2 (38 ± 7% vs. 70 ± 6%; p < 0.0001), independent of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all), and lower than expected in the general population (p < 0.001). Freedom from cardiac events was lower with an ERO ≥40 mm2 versus <40 mm2 independently of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all). Cardiac surgery for severe isolated TR was rarely performed (16 ± 5% 5 years after diagnosis). CONCLUSIONS: Isolated TR can be severe and is associated with excess mortality and morbidity, warranting heightened attention to diagnosis and quantitation. Quantitative assessment of TR, particularly ERO measurement, is a powerful independent predictor of outcome, superior to standard qualitative assessment.

KW - Effective regurgitant orifice

KW - Isolated tricuspid regurgitation

KW - Prognosis

KW - Tricuspid regurgitation

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