Abstract
Abstract Background Right ventricular (RV) function is regarded as an important prognostic factor for significant tricuspid regurgitation (TR). Our previous study using a step-by-step approach to classified phenotypes of TR has shown different phenotypes of TR had different effects on RV function. We believed RV function also played different roles in diffident phenotypes for prognosis. Methods There were 670 patients (7.7%) exhibited moderate to severe TR in our echocardiography laboratory from January to June 2018. These participants were classified into 8 phenotypes by a step-by-step approach including primary TR, secondary TR related to RV instrumentation, related to left heart disease, related to congenital heart disease, related to pulmonary hypertension, related to RV myopathy, atrial TR, and true idiopathic TR. Combined outcome endpoints included death, heart failure, acute coronary syndrome, stroke, and new arrhythmia. RV function was measured by fractional area change (FAC) from apical 4 chamber view. Results After mean follow-up 43.2 ± 27.9 months, there were 28 participants lost follow-up. We included 4 major groups for analysis included primary TR (11.1%), secondary TR related to left heart disease (39.4%), related to pulmonary hypertension (15.4%), true idiopathic TR (13.5%). Different phenotypes demonstrated different rates of outcomes included 43.7% in primary TR, 58.1% in left heart disease, 51.5% in pulmonary hypertension, and 29.9% in true idiopathic TR. After multivariate COX regression analysis, independent factors for prognosis were different among these groups. Left ventricular ejection fraction (HR 0.950, 95% CI 0.905-0.998) but not RV FAC was independent prognostic factor in primary TR. Age (HR 1.019, 95% CI 1.004-1.034), eGFR (HR 0.985, 95% CI 0.977-0.993), and RV FAC (HR 0.978, 95% CI 0.964-0.992) were independent predictors for prognosis in secondary TR related to left heart disease. Age (HR 1.047, 95% CI 1.016-1.079), systolic pulmonary artery pressure (HR 1.014, 95% CI 1.003-1.025), and RV FAC (HR 0.972, 95% CI 0.947-0.999) were independent prognostic factors in TR related to pulmonary hypertension. In true idiopathic TR, only right atrial area (HR 1.124, 95% CI 1.015-1.245) was independent prognostic factor. Conclusion RV function as prognostic factor was only noted in TR related to left heart disease and pulmonary hypertension. Different phenotypes had different prognostic factors. TR should not be treated as a single disease.
Published Version
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