Assessment of multicausality in tricuspid regurgitation

Abstract

Abstract Introduction Tricuspid regurgitation (TR) is a condition with multiple etiologies. The increased clinical knowledge of this pathology in recent years has led to a paradigm shift in its classification, with the latest literature advocating for stratification based on the pathophysiological profile beyond the classical division into primary and secondary or functional causes. In this study, we aimed to evaluate the possible concomitant causes of TR in a large series of patients classified into different groups according to their clinical profile. Methods Multicenter and retrospective study that included a series of consecutive patients with significant TR (moderate to severe or greater) diagnosed between 2002 and 2017. The patients were classified by the type of TR based on their main clinical context. For this purpose, we followed the step-by-step classification proposed by Topilsky et al so that the type of TR was defined in the first step that met the established criteria. Subsequently, an individual analysis of each of the obtained groups was performed to detect other possible causal mechanisms of TR. Results A total of 778 patients with significant TR were included and classified into 6 groups according to their clinical profile following the proposed classification (see attached image). Functional TR associated with left-sided valvular disease (56.16%) was the most frequent group observed. The attached table shows the different groups and concomitant pathologies. In those with primary etiology (congenital and acquired), only 33.33% and 25%, respectively, had no other etiology defined. Among the functional causes, those with TR associated with left-sided valvular disease did not present other causal mechanisms in 62.92% of cases, and 66.66% of cases in the group with TR associated with ventricular dysfunction did so. The functional groups associated with pulmonary hypertension and atrial cause did not present other notable concomitant causes as they were at the end of the classification. Conclusions In a large series of patients with significant TR, up to 31.87% of the sample showed other possible concomitant causes of TR apart from their main clinical profile, and this percentage was even higher in patients with primary causes. Given that the clinical course of this entity has been shown to differ according to the type of TR, this suggests that in approximately one-third of our patients with significant TR, a more descriptive and exhaustive etiological classification may be necessary to understand their prognosis and establish the best therapeutic strategy.Flow-chart and classification.Concomitant pathologies.