title: Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure.
abstract: OBJECTIVE
  Renal dysfunction is common in heart failure. Recent evidence suggests a pivotal role for systemic venous congestion and functional tricuspid regurgitation (FTR) in the pathophysiology of renal dysfunction. We investigated the role of FTR as a determinant of renal dysfunction and a predictor of long-term prognosis in chronic systolic heart failure patients.
  
  
  RESULTS
  Four hundred and thirteen consecutive patients (mean age 74.2 ± 11 years) with chronic heart failure and left ventricular ejection fraction below 50% were enrolled. The FTR severity was quantified by transthoracic echocardiography. Renal function was evaluated with the estimated glomerular filtration rate measured by the simplified Modification of Diet in Renal Disease formula. The association between moderate/severe FTR and renal dysfunction, and its impact on heart failure episodes and overall mortality were also assessed. The median follow-up was 36 months (range 1-144 months). Through multivariate analysis, the interaction between moderate/severe FTR with tricuspid annular plane systolic excursion less than 16 mm was found to be an independent determinant of renal dysfunction [odds ratio 1.2, 95% confidence interval (CI) 1.1-1.5, P = 0.04]. Moderate/severe FTR (hazard ratio 1.3, 95% CI 1.2-2.7, P = 0.02) and tricuspid annular plane systolic excursion below 16 mm (hazard ratio 1.2, 95% CI 1.0-3.7, P = 0.01) were significantly related to the heart failure episodes. Moreover, the Kaplan-Meier analysis showed a worse outcome in patients with moderate/severe FTR (log-rank test 8.6, P = 0.003).
  
  
  CONCLUSIONS
  The combination of significant FTR and right ventricular dysfunction, but not FTR and right ventricular dysfunction alone, is independently associated with renal dysfunction. The presence of significant FTR is related to an excess event rate of heart failure and has significant impact on outcome.
authors.affiliation: aEchocardiography Laboratory bDivision of Cardiac Surgery, San Raffaele Hospital, IRCCS, Milan, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Claudia
authors.initials: C
authors.lastname: Marini
authors.forename: Stefano
authors.initials: S
authors.lastname: Stella
authors.forename: Alberto
authors.initials: A
authors.lastname: Monello
authors.forename: Andrea
authors.initials: A
authors.lastname: Fisicaro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tufaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Slavich
authors.forename: Michele
authors.initials: M
authors.lastname: Oppizzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castiglioni
authors.forename: Alberto
authors.initials: A
authors.lastname: Cappelletti
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000401:mortality*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
chemical_list: D003404:Creatinine