title: Impact of tricuspid regurgitation on long-term survival.
abstract: OBJECTIVE
  The goal of this study was to examine mortality associated with tricuspid regurgitation (TR) after controlling for left ventricular ejection fraction (LVEF), right ventricular (RV) dilation and dysfunction, and pulmonary artery systolic pressure (PASP).
  
  
  BACKGROUND
  Tricuspid regurgitation is a frequent echocardiographic finding; however, the association with prognosis is unclear.
  
  
  METHODS
  We retrospectively identified 5,223 patients (age 66.5 +/- 12.8 years; predominantly male) undergoing echocardiography at one of three Veterans Affairs Medical Center laboratories over a period of four years. Follow-up data were available for four years (mean 498 +/- 402 days). Kaplan-Meier and proportional hazards methods were used to compare differences in survival among TR grades.
  
  
  RESULTS
  Mortality increased with increasing severity of TR. The one-year survival was 91.7% with no TR, 90.3% with mild TR, 78.9% with moderate TR, and 63.9% with severe TR. Moderate or greater TR was associated with increased mortality regardless of PASP (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.16 to 1.49 for PASP >40 mm Hg; HR 1.32, 95% CI 1.05 to 1.62 for PASP < or =40 mm Hg) and LVEF (HR 1.49, 95% CI 1.34 to 1.66 for EF <50%; HR 1.54, 95% CI 1.37 to 1.71 for EF > or =50%). When adjusted for age, LVEF, inferior vena cava size, and RV size and function, survival was worse for patients with moderate (HR 1.17, 95% CI 0.96 to 1.42) and severe TR (HR 1.31, 95% CI 1.05 to 1.66) than for those with no TR.
  
  
  CONCLUSIONS
  We conclude that increasing TR severity is associated with worse survival in men regardless of LVEF or pulmonary artery pressure. Severe TR is associated with a poor prognosis, independent of age, biventricular systolic function, RV size, and dilation of the inferior vena cava.
authors.affiliation: Department of Medicine, Division of Cardiology, Veterans Affairs Medical Center, 3801 Miranda Avenue 111C, Palo Alto, CA 94304, USA. jayant@pol.net
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D004108:Dilatation, Pathologic / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology