title: Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure.
abstract: BACKGROUND
  Tricuspid regurgitation (TR) is a common echocardiographic finding that has been related to adverse outcome under various clinical scenarios. Nevertheless, evidence supporting its prognostic value in heart failure (HF) is scarce, and, in most cases, contradictory. We evaluated the association of TR grade with 1-year all-cause mortality in acute HF (AHF). METHODS AND RESULTS: We included 1,842 consecutive patients admitted for AHF. Mean age was 72.8±11.3 years, 51% were female and 45.5% had LVEF <50%. The severity of TR was graded in non-TR, mild (1), moderate (2), moderate-severe (3) and severe (4). At 1-year follow-up, 370 patients (20.1%) had died. In patients with LVEF ≥50%, a significant and positive association between TR severity and mortality was noted. Indeed, the HR for mortality for TR 3 and 4 vs. no TR/TR 1 were as follows: hazard ratios (HR), 1.68; 95% confidence intervals (95% CI): 1.08-2.60, P=0.02; and HR, 2.87; 95% CI: 1.61-5.09, P<0.001, respectively. In contrast, no association between TR grade and mortality (P=0.650) was observed in patients with LVEF <50% (P-value for interaction=0.033).
  
  
  CONCLUSIONS
  A differential prognostic effect of TR severity on 1-year mortality was observed for LVEF HF status. The association was significant only in patients with LVEF ≥50%, with increasing mortality risk as TR became more severe.
authors: Cardiology Department, Clinical University Hospital, INCLIVA, University of Valencia.
authors: Enrique
authors: E
authors: Santas
authors: Francisco Javier
authors: FJ
authors: Chorro
authors: Gema
authors: G
authors: Miñana
authors: José
authors: J
authors: Méndez
authors: Jaime
authors: J
authors: Muñoz
authors: David
authors: D
authors: Escribano
authors: Sergio
authors: S
authors: García-Blas
authors: Ernesto
authors: E
authors: Valero
authors: Vicent
authors: V
authors: Bodí
authors: Eduardo
authors: E
authors: Núñez
authors: Juan
authors: J
authors: Sanchis
authors: Julio
authors: J
authors: Núñez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left