1. Determinants of Tricuspid Regurgitation Progression and Its Implications for Adequate Management.
- Author
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Arteagoitia Bolumburu A, Monteagudo Ruiz JM, Mahia P, Pérez David E, González T, Sitges M, Li CH, Alonso D, Carrasco F, Luna Morales M, Adeba A, de la Hera JM, and Zamorano JL
- Subjects
- Humans, Male, Female, Aged, Prospective Studies, Middle Aged, Risk Factors, Time Factors, Prognosis, Severity of Illness Index, Heart Failure physiopathology, Heart Failure mortality, Heart Failure therapy, Heart Failure diagnostic imaging, Hospitalization, Predictive Value of Tests, Age Factors, Ventricular Function, Left, Aged, 80 and over, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency physiopathology, Tricuspid Valve Insufficiency mortality, Disease Progression, Tricuspid Valve diagnostic imaging, Tricuspid Valve physiopathology
- Abstract
Background: Tricuspid regurgitation (TR) is associated with an increased mortality. Previous studies have analyzed predictors of TR progression and the clinical impact of baseline TR. However, there is a lack of evidence regarding the natural history of TR: the pattern of change and clinical impact of progression., Objectives: The authors sought to evaluate predictors of TR progression and assess the prognostic impact of TR progression., Methods: A total of 1,843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. All patients with less than a 2-year follow-up were excluded. Clinical and echocardiographic features, hospitalizations for heart failure, and cardiovascular death and interventions were recorded to assess their impact in TR progression., Results: At a median 2.3-year follow-up, 19% of patients experienced progression. Patients with baseline moderate TR presented a rate progression of 4.9%, 10.1%, and 24.8% 1 year, 2 years, and 3 years, respectively. Older age (HR: 1.03), lower body mass index (HR: 0.95), chronic kidney disease (HR: 1.55), worse NYHA functional class (HR: 1.52), and right ventricle dilation (HR: 1.33) were independently associated with TR progression. TR progression was associated with an increase in chamber dilation as well as a decrease in ventriculoarterial coupling and in left ventricle ejection fraction (P < 0.001). TR progression was associated with an increased cardiovascular mortality and hospitalizations for heart failure (P < 0.001)., Conclusions: Marked individual variability in TR progression hindered accurate follow-up. In addition, TR progression was a determinant for survival regardless of initial TR severity., Competing Interests: Funding Support and Author Disclosures This study was supported by the Instituto de Salud Carlos III, PI20/01206. Dr Sitges has received consulting and lecture fees from General Electric, Canon Medical, Medtronic, Edwards Lifesciences, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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