Severity of tricuspid regurgitation (TR) only based in echo parameters? The failure of guidelines. The 4A in patients with significant TR as a new clinical score to evaluate patients with TR

Abstract

Abstract Background Significant Tricuspid Regurgitation (TR) is associated with increased morbi-mortality. Symptoms due to TR are often insidious and not always characterized by dyspnea. Identification of symptoms and optimal timing for intervention is challenging and intervention is often preformed late. A more specific clinical classification focused on the detection of systemic congestion may help identify those who may benefit from an earlier intervention. Purpose To evaluate the prognostic impact of a new proposed “4A” clinical score: Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia, in patients with significant TR. Methods Consecutive patients in stable clinical condition evaluated in the Heart Valve Clinic with significant TR (moderate to severe, severe, massive or torrential TR) were included. Signs and symptoms of Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia (“4A score”) where registered, follow up was performed every 6 months. The 4A clinical score ranged from 0 (no A) to 4 (all four A's present). The difference in the 4A score between the first and last visit was determined. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined. Results 86 patients were included in this study (age 76±11 years, 70% female, 87% functional TR). At first visit, 92% were in NYHA class I or II and 77% had a 0 or 1 “4A score”. After a median follow-up of 24 months (IQR: 11–35 months), “4A score” was significantly impaired (score mean difference: 0.42±0.8) and only 59% remained with a 0 or 1 “4A score”. 32.6% of the patients (n=28) experienced the combined endpoint. The change in 4A score was a significant predictor of events (hazard ratio per unit 1.88 [1.22–2.88], p=0.004) Conclusion We demonstrate for the first time a new clinical score predictive of right heart failure and death in patients with significant TR. Funding Acknowledgement Type of funding sources: None.