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Bannehr M, Edlinger CR, Kahn U, Liebchen J, Okamoto M, Hähnel V, Dworok V, Schipmann F, Kücken T, Bramlage K, Bramlage P, Haase-Fielitz A, Butter C. Natural course of tricuspid regurgitation and prognostic implications. Open Heart 2021; 8:openhrt-2020-001529. [PMID: 33563777 PMCID: PMC7875290 DOI: 10.1136/openhrt-2020-001529] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR. Methods In this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors. Results At baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006). Conclusion While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.
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Affiliation(s)
- Marwin Bannehr
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany .,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | - Christoph Roland Edlinger
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany.,Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ulrike Kahn
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Josephin Liebchen
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Maki Okamoto
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Valentin Hähnel
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | - Victoria Dworok
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | - Fabian Schipmann
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | - Tanja Kücken
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | - Karin Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anja Haase-Fielitz
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany.,Institute of Social Medicine & Health Care System Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Faculty of Health Sciences Brandenburg, Potsdam, Germany
| | - Christian Butter
- Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany.,Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Potsdam, Germany
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Kücken T, Tamm S, Haase-Fielitz A, Edlinger CR, Neuss M, Bannehr M, Butter C. Visualisation of the tricuspid valve using a new 3D echocardiographic scoring system. Open Heart 2020; 7:openhrt-2020-001363. [PMID: 32994355 PMCID: PMC7526282 DOI: 10.1136/openhrt-2020-001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022] Open
Abstract
With rising focus on interventional treatment of the tricuspid valve (TV), the need for good echocardiographic imaging increases. Aim of this study was to develop a scoring system describing how accurate three dimensional (3D) echocardiographic imaging of TV and its anatomical structures is.
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Affiliation(s)
- Tanja Kücken
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Sarah Tamm
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Anja Haase-Fielitz
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | | | - Michael Neuss
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Marwin Bannehr
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Christian Butter
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
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