title: Echocardiographic Determinants of One-Year All-Cause Mortality in Patients With Chronic Heart Failure Complicated by Significant Functional Tricuspid Regurgitation.
abstract: BACKGROUND
  Right ventricular (RV) dysfunction plays an important role in chronic heart failure (CHF). We evaluated the echocardiographic determinants of 1-year all-cause mortality in CHF patients with clinically relevant functional tricuspid regurgitation (TR).
  
  
  RESULTS
  A total of 101 consecutive CHF patients (mean age 74 ± 10 years, 53% male) with moderate or severe functional TR were enrolled. Each patient underwent at least 2 echocardiography examinations in an interval of >6 months. Clinical follow-up was made after a median of 305 (interquartile range 164-365) days after the last echocardiography. The primary end point was all-cause mortality. Forty-two patients (42%) died during follow-up. Baseline right atrial (RA) area, TR volume increase and RV enlargement over time were significantly higher in nonsurvivors than survivors (all P < .05). Compared to baseline levels, systolic pulmonary artery pressure (sPAP) was significantly reduced in nonsurvivors during follow-up echocardiography (54 ± 19 vs 49 ± 21 mm Hg; P = .010), but significantly increased in survivors (48 ± 17 vs 54 ± 17 mm Hg; P = .001). Multivariable survival analysis suggested that baseline RA area ≥27 cm2(hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.21-4.80; P = .013), follow-up TR proximal isovelocity surface area regurgitant volume increase ≥15 mL (HR 2.27, 95% CI 1.20-4.31; P = .012), RV middle diameter increase ≥10 mm (HR 2.38, 95% CI 1.10-5.11; P = .027), and sPAP reduction ≥10 mm Hg (HR 3.04, 95% CI 1.51-6.13; P = .002) were determinants of 1-year all-cause mortality after the last echocardiography. Patients with 2 or 3 of these determinants were faced with significantly increased 1-year mortality (88% or 100%).
  
  
  CONCLUSIONS
  Dynamic RV morphologic and functional changes during serial echocardiography are associated with significantly increased mortality risk in CHF patients with moderate or severe functional TR.
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Hu
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Herrmann
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oder
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Voelker
authors.affiliation: Innere Klinik II, Katharinen-Hospital Unna, Unna, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Weidemann
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, Würzburg, Germany. Electronic address: nordbeck_p@ukw.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Nordbeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography / Q000401:mortality* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Chronic heart failure; prognosis; systolic pulmonary artery pressure; tricuspid regurgitation