title: Predictive factor of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis: the importance of myocardial hypertrophy and diastolic dysfunction.
abstract: OBJECTIVE
  The aim of this study is to determine the predictors of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis.
  
  
  METHODS
  Seventy-one patients, who underwent aortic valve replacement for aortic stenosis at our institute from January 2006 to July 2011, were divided into two groups: an STR group, which included 15 patients with moderate or greater than moderate secondary tricuspid regurgitation at a follow-up visit and a control group. Echocardiography was performed before surgery, at discharge, and at a late follow-up visit (mean follow-up 36 ± 19 months, range 0-77).
  
  
  RESULTS
  Preoperatively, the number of women (p < .01), body surface area (p < .001), and relative wall thickness (0.60 ± 0.15 vs 0.71 ± 0.13, p = .022) showed significant differences between the two groups. At a follow-up visit, moderate or severe mitral regurgitation (p = .0001) and severe diastolic dysfunction (p = .003) showed significant differences between the two groups. In the Cox regression analysis, moderate or severe mitral regurgitation at follow-up (p = .038, hazard ratio 4.394, 95% CI 1.085-17.791) was the only independent predictor of secondary tricuspid regurgitation.
  
  
  CONCLUSIONS
  This study suggested that preoperative concentric myocardial hypertrophy and diastolic dysfunction were associated with development of the secondary tricuspid regurgitation at late follow-up.
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan. igao5150@fmu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Cardiovascular Surgery, Ohta-Nishinouchi General Hospital, Fukushima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanji
authors.affiliation: Department of Cardiovascular Surgery, Ohta-Nishinouchi General Hospital, Fukushima, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Cardiovascular Surgery, Ohta-Nishinouchi General Hospital, Fukushima, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Aortic stenosis; Aortic valve replacement; Concentric myocardial hypertrophy; Diastolic dysfunction; Secondary tricuspid regurgitation