Is functional tricuspid regurgitation decrease under diuretic correlated with outcome?

Abstract

Functional tricuspid regurgitation (FTR) is often assessed after diuretic treatment. Cardiac surgery may be postponed when FTR severity decreases. The aim of our study was to evaluate if this decrease may improve patient outcome. We retrospectively included 91 patients (71 ± 14 years, 58% male) hospitalized for heart failure with a moderate ( n = 53) to severe FTR ( n = 38). All patients were discharged with a median daily furosemide dose of 125 mg [65–500 mg]. None were referred to cardiac surgery because of operative risk. FTR severity was reassessed within 6-month and compared to one-year cardiovascular mortality. During the follow-up, decrease in FTR severity was reported in 22 (24%) patients [17 in intially severe FTR group]. This improvement was not sustained for 40% of patients and progression to a severe grade was observed in 18/53 patients with initially a moderate FTR. Changes in PISA radius correlated with changes in inferior vena cava and right ventricular sizes but not with furosemide dose. One-year cardiovascular mortality ( n = 29, 32%) was similar in patients with initially moderate (38%) and severe FTR (24%, P = 0.16, Fig. 1 , panel A). Cardiovascular mortality was also similar irrespective of changes in FTR severity under diuretic (23% for decrease, 31% for unchanged and 44% for increase in FTR severity, P = 0.35, Fig. 1 , panel B). Furosemide dose at discharge was the only independent predictor of mortality (OR 1.20 [1.10–1.40] per 10 mg furosemide, P < 0.01) and correlated with uremia and severe left ventricular dysfunction (LVEF < 35%). Moderate and severe FTR medically treated share the same outcome and decrease in FTR severity has no impact on mortality. Furosemide dose is an independent marker of adverse outcome and indicates the stage of renal and cardiac dysfunctions.