title: Impact of tricuspid regurgitation on survival in patients with chronic heart failure: unexpected findings of a long-term observational study.
abstract: OBJECTIVE
  Tricuspid regurgitation (TR) is common in patients with chronic heart failure (CHF) but its prognostic impact is unclear.
  
  
  RESULTS
  A total of 576 consecutive patients with CHF were prospectively included. The impact of moderate and severe (significant) TR on the combined endpoint death/heart transplantation/left ventricular-assist device implantation was assessed. Patients were followed for 5.8 ± 4.2 (maximum 14.4) years. Kaplan-Meier analysis showed a worse outcome of patients with significant TR (P < 0.0001). By multivariable analysis, amino terminal pro B-type natriuretic peptide (NT-proBNP) (P = 0.0028), systolic left ventricular function (LVF) (P = 0.0014), serum sodium, NYHA functional class, systolic blood pressure, right atrial size (all P = 0.0001), but not TR were significantly related with the outcome. However, as soon as the strong interaction between TR and LVF was included in the model, significant TR determined outcome as well (P = 0.0059). Therefore, in a second analysis patients were stratified for LVF. In patients with mildly or moderately impaired LVF, TR was significantly related with the outcome (HR: 1.368, CI: 1.070-1.748, P = 0.0125), whereas in patients with severely depressed LVF it was not (P = 0.1401). As a proof of concept, we additionally stratified patients according to serum NT-proBNP concentrations. In patients with NT-proBNP concentrations below the median (≤ 280 fmol/mL), TR was related with the outcome (HR: 2.512, CI: 1.127-5.597, P = 0.0242) but it was not in patients with NT-proBNP concentrations above the median (P = 0.3935).
  
  
  CONCLUSIONS
  The prognostic impact of TR depends on the severity of CHF. While TR was significantly related with excess mortality in mild to moderate CHF, it provided no additive value in advanced disease when compared with established risk factors.
authors: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors: Stephanie
authors: S
authors: Neuhold
authors: Martin
authors: M
authors: Huelsmann
authors: Elisabeth
authors: E
authors: Pernicka
authors: Alexandra
authors: A
authors: Graf
authors: Diana
authors: D
authors: Bonderman
authors: Christopher
authors: C
authors: Adlbrecht
authors: Thomas
authors: T
authors: Binder
authors: Gerald
authors: G
authors: Maurer
authors: Richard
authors: R
authors: Pacher
authors: Julia
authors: J
authors: Mascherbauer
mesh_terms: D002908:Chronic Disease; D004562:Electrocardiography; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D014262:Tricuspid Valve Insufficiency / Q000401:mortality*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain