Rate of progression of tricuspid regurgitation and clinical implications

Abstract

Abstract Background Tricuspid regurgitation (TR) is a prevalent valvular disease. Recent studies demonstrated that significant TR is associated with an increased mortality. However, information regarding the progression rate of TR is lacking, crucial for the correct clinical evaluation of such patients. Due to this fact, current guidelines fail to propose a scheduled follow-up programme in patients with significant TR; contrary to patients with left-sided valvular disease. The aim of this study is to examine the rates of TR progression and its clinical implications. Objectives To analyse the rate of progression of TR during follow-up and evaluate the impact of TR progression in hospitalizations due to heart failure (HF) or cardiovascular (CV) death. Methods 1843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. Clinical and echocardiographic features were recorded to assess their impact in TR progression. TR progression was defined as at least worsening of one grade according to Hahn and Zamorano classification based on Vena contracta width and effective regurgitant orifice area. The cumulative event rates were estimated with the Kaplan-Meyer method and compared by means of the log-rank test. Results Median follow-up time was 3.7 (IQR: 1.2 to 3.8) years. During the follow-up period, death occurred in 525 patients (28.5%); due to cardiovascular causes in 174 (9.4%) of them. Figure 1 shows the incidence of TR progression from moderate to at least severe TR during follow-up period. Moderate TR had 4.9%, 10.1% and 24.8% 1-year, 2-year and 3-year risk of progression to at least severe TR, respectively. The combined endpoint of cardiovascular mortality and hospitalization for heart failure was higher among progressors (23.5% vs. 37.7%; log rank P < 0.001, Figure 2). Conclusions Progression of TR is associated with an increased risk of hospitalizations and cardiovascular mortality. According to the rate of progression in our study, we support serial echocardiographic testing for these patients similar to that proposed by current guidelines for left-sided heart disease. However, we still need evidence of the impact of serial testing in TR.Incidence of TR progression from moderatKaplan Meier survival curves free from h