Abstract
Tricuspid regurgitation (TR) has a considerable prevalence in the overall population, that further increases in selected categories of patients. Three morphologic types of TR prevail, namely primary, secondary and atrial TR, mostly, but not always, occurring in different subsets of patients. Recent evidences demonstrate a negative impact of TR on outcomes, irrespective of etiology and even when less than severe in grading. Unfortunately, current surgical standards are void of strong prospective evidence of positive impact on clinical outcomes. While on one hand recent advances in diagnosis and risk stratification of patients with TR are shedding light onto the population that may benefit from intervention and its appropriate timing, on the other hand the arrival on stage of percutaneous treatment options is widening even more the therapeutic options for such population. In this review we will address and discuss the available evidence on the prognostic impact of TR in different clinical contexts encountered in practice.
Highlights
Progressive accrual of insights into the prevalence, pathophysiology, natural history and clinical relevance of tricuspid regurgitation (TR) has been witnessed in recent years [1,2,3,4], and treatment of TR gradually shifted from a conservative to a more interventional therapeutic and preventive approach
While primary TR is due to an abnormality of the tricuspid valve (TV) apparatus, TR may be caused by dilation of TV annulus, right ventricular (RV) remodeling and leaflet tethering secondary to left heart disease and pulmonary hypertension, or caused by atrial fibrillation (AF) and right atrium (RA) remodeling [4,5,6]
Recent evidence from several studies suggests that significant TR impacts negatively patient prognosis (Fig. 2) [7,15,22], and that it does so more and more for every increase in grade of severity [23,27]. This might be well explained by the fact that chronic RV volume overload due to self-perpetuating significant TR may result in progressive RV dilation and remodeling, which in turn might lead to progressive irreversible RV myocardial damage and symptomatic right heart failure [28]
Summary
TR is a common echocardiographic finding, reported in up to 70 to 90% of adults [1] and clinically relevant TR is found in approximately 4% of subjects aged 75 years [2]. Low cardiac output might be due to the relevant amount of regurgitant flow at expense of forward flow, and due to the inability to proportionally increase cardiac output to metabolic needs related to increased left heart pressures caused by diastolic ventricular interaction and pericardial restraint [29,30]. In the end, such natural history suggests a non-marginal role of TR in disease, especially upon the onset of the vicious cycle encompassing RV myocardial damage and remodeling. Publisher’s Note: IMR Press stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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