Characteristics and prognosis of patients with significant tricuspid regurgitation

Abstract

Severe tricuspid regurgitation (TR) usually remains asymptomatic for a long period, and the diagnosis is often delayed, at an advanced stage of right heart failure (RHF). Only a minority of patients are referred to surgery. To describe the characteristics and prognosis according to aetiologies of patients with significant TR. Two hundred and eight consecutive patients with moderate-to-severe (grade III) or severe (grade IV) TR were included from echocardiography reports between 2013 and 2017. Median follow-up was 18(6-38) months. Patients (mean age 75 years, 46.6% males) were divided into 4 groups according to TR aetiology, group 1: primary TR (15%), group 2: TR secondary to left heart or pulmonary disease with a history of left heart valve surgery (24.5%), group 3: TR secondary to left heart disease with no history of left valvular surgery (26.4%) and group 4: idiopathic TR (34.1%). During follow-up, 61 patients (29%) experienced at least one decompensation of RHF requiring hospitalization. Only 11 patients (5.3%) underwent tricuspid valve surgery during follow-up with a perioperative mortality of 36%. The 4 years survival was much lower than the expected survival of age- and sex-matched individuals of the general population (56 ± 4% vs. 74%). After adjustment for outcome predictors, patients with idiopathic TR had a higher risk of mortality (adjusted HR = 1.83 [1.05–3.21]; P = 0.034) compared to other groups ( Fig. 1 ). Moderate-to-severe and severe TR is associated with a high risk of hospitalization for RHF and death at 4 years and a low rate of surgery. Idiopathic TR is associated with worse outcome than other etiologies.