Sex influence in the etiology and long-term prognosis of significant tricuspid regurgitation

Abstract

Abstract Introduction It is widely recognized that significant tricuspid regurgitation is more frequent in women, but there is practically no information on the prognostic differences according to sex in the different etiological groups. Our objective was to analyze the impact of sex on the frequency and prognosis according to the etiological group. Methods Retrospective multicenter study that included consecutive patients with significant tricuspid regurgitation (moderate-severe degree or greater) diagnosed between 2002 and 2017 in 3 referral hospitals. We retrospectively classified the patients according to sex and type of tricuspid regurgitation based on clinical and echocardiographic data. The type of tricuspid regurgitation was defined in the first step that met the established criteria, differentiating between congenital and organic etiology (structural tricuspid disease), left valve disease (mild mitral stenosis or another at least moderate valve disease), ventricular dysfunction, associated with pulmonary hypertension, or atrial (by not fulfilling any of the above and presenting atrial dilatation). Subsequently, we compared prevalence and mortality from all causes according to sex for each etiology. Results A total of 778 patients were included, 71% women. The median follow-up was 40.2 months (interquartile range 11.2-80.9). When comparing the frequency of each etiological group according to sex, we only found significant differences in tricuspid regurgitation associated with ventricular dysfunction (9.7% men vs 3.1% women, p <0.001). In terms of survival, we found significant differences with higher survival in women with organic etiologies (92.4 months in women vs 54.1 in men, p=0.021), secondary to valve disease (79.6 months in women vs 54.1 in men, p<0.001) or pulmonary hypertension (58.9 months in women vs 28.7 in men, p=0.01). In the rest of the etiological groups, differences were not statistically significant. Figure shows Kaplan-Meier survival curves based on each etiology for each gender. Conclusions Significant tricuspid regurgitation was observed in a higher percentage of women (71%). Regarding the frequency for each type of tricuspid regurgitation, only significant differences were found in the etiology secondary to ventricular dysfunction, being more frequent in men. Regarding the survival curves, significant differences were found with greater survival in the group of women in organic tricuspid regurgitation, secondary to valve disease and secondary to pulmonary hypertension.Kaplan Meier survival curves