title: Prognostic implications of tricuspid regurgitation in patients with severe aortic regurgitation: results from a cohort of 756 patients.
abstract: Tricuspid regurgitation (TR) is common, but neglected. We evaluated the prognostic implications of TR in a cohort of 756 patients with severe aortic regurgitation (AR). A cohort of 756 patients with AR was identified from our echocardiographic database. Chart reviews were performed. Survival as a function of TR severity was analysed. Of the 756 patients with severe AR, 264 (35%) had ≥ 2+ TR. Univariate correlates of TR were older age (P < 0.0001), female gender (P < 0.0001), lower left ventricular ejection fraction (P < 0.0001), atrial fibrillation (P < 0.0001), presence of a pacemaker (P < 0.0001), higher PASP (P < 0.0001), presence of 3 or 4+ mitral regurgitation (P < 0.0001) and not being on a beta-blocker (P < 0.0001) or statins (P = 0.007). After adjusting for group differences, ≥ 2+ TR was an independent predictor of higher mortality (RR 1.47, P = 0.005). Aortic valve replacement (AVR) was independently associated with improved survival in patients with ≥ 2+ TR. (RR 0.46, 95% CI 0.36-0.60, P < 0.0001). In conclusion, in severe AR patients, ≥ 2+ TR is independently associated with a higher mortality. The performance of AVR in these patients with ≥ 2+ TR is associated with a survival benefit. Development of ≥ 2+ TR in these patients is a marker of decompensation and should serve as an indication for AVR.
authors.affiliation: Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000401:mortality; D002140:California / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D014463:Ultrasonography; D016277:Ventricular Function, Left