title: Prognostic variables for clinical outcomes in valvular heart disease patients with moderate to severe secondary tricuspid regurgitation.
abstract: OBJECTIVE
  Secondary tricuspid regurgitation (STR) is frequently seen in cardiology practice. Currently, few data are available on the prognostic variables associated with moderate or severe STR on death and progression to valve surgery. Hence, the study aim was to identify these prognostic variables.
  
  
  METHODS
  In this retrospective study, patients with at least moderate STR were identified from an ongoing database and followed until death, any valvular heart surgery, or the end of the study. Clinical and echocardiographic variables including age, gender, coronary artery disease, device implantation (defibrillator or pacemaker), pulmonary disease, left ventricular ejection fraction, right ventricular size, right ventricular systolic pressure (RVSP), STR severity and concomitant valve disease were recorded. End-points were death and valve surgery.
  
  
  RESULTS
  The average age of the 92 study participants was 68 +/- 16 years. During a mean follow up of 43 +/- 24 months, there were 13 deaths (14%) and 12 surgeries (13%). In multivariate analysis, both an elevated RVSP and device implantation were significant predictors of death (p = 0.0038 and 0.0487, respectively). Only an elevated RVSP was predictive of surgery (p = 0.05) and surgery-free survival (p = 0.0005). A RVSP > 48 mmHg had a hazard ratio of 3.93 (p = 0.0012) and a high diagnostic accuracy for predicting death, with an area under the receiver operating characteristic curve of 0.73.
  
  
  CONCLUSIONS
  In patients with valvular heart disease and at least moderate STR, an elevated RVSP of at least 48 mmHg was associated with significantly increased mortality and decreased surgery-free survival.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA.
authors.forename: Manish B
authors.initials: MB
authors.lastname: Jhawar
authors.forename: Albert K
authors.initials: AK
authors.lastname: Chan
authors.forename: Sara Z
authors.initials: SZ
authors.lastname: Baig
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Calaluce
authors.forename: Annamalai
authors.initials: A
authors.lastname: Senthilkumar
authors.forename: Gong-Yuan
authors.initials: GY
authors.lastname: Xie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006334:Heart Function Tests / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D014481:United States