Background: The clinical outcome and its predictors of isolated tricuspid regurgitation (TR), which is not associated with left sided heart disease, are poorly defined. We sought to investigate the determinants of outcomes of severe isolated TR.
Methods: We enrolled 74 consecutive patients (34 males; mean age, 63 ± 12 years) with severe isolated TR, who satisfied the following criteria: (1) TR jet area>30% of right atrial area, (2) plethora of inferior vena cava and systolic flow reversal of hepatic vein. The primary end points were hospitalization due to worsening heart failure (HF), tricuspid valve surgery and cardiovascular death.
Results: During the mean follow-up period of 56 ± 34 months, there were 25 events (3 cardiovascular deaths, 9 tricuspid valve surgery and 13 hospitalizations due to worsening HF). Univariate Cox analysis showed that younger age, female gender, larger effective regurgitant orifice, right atrium and right ventricle and vena contracta width (VCW) were found to be associated with cardiovascular events. Increased tricuspid valve tethering distance and tethering area were also associated with cardiovascular events. In multivariate Cox regression analysis, larger VCW (HR, 1.69; 95% CI: 1.07 – 2.67, P = 0.02) was found to be an independent predictor of cardiovascular events. As compared with patients with a VCW less than 7.0 mm, those with a VCW more than 7.0 mm had poorer long-term outcome (adjusted HR 19.9, P<0.01).
Conclusion: In severe isolated TR, VCW is a powerful independent predictor of adverse outcomes. Since long-term outcome is related directly to the severity of TR as defined by VCW, VCW should be measured routinely in patients with severe TR.
Figure. Kaplan-Meier curves showing time to cardiovascular events for patients with VCW ≤ 7 mm versus > 7 mm
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