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Margonato D, Ancona F, Cesari A, Ghantous E, Ingallina G, Melillo F, Stella S, Biondi F, Belli M, Montalto C, Manini C, Montorfano M, De Bonis M, Maisano F, Topilsky Y, Agricola E. The long-term clinical course of moderate tricuspid regurgitation. Int J Cardiol 2023; 387:131135. [PMID: 37364718 DOI: 10.1016/j.ijcard.2023.131135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND To evaluate the long-term clinical outcome of a cohort of patients suffering from moderate tricuspid regurgitation (TR), regardless of its etiology. METHODS Clinical and echocardiographic follow-up were assessed in 250 patients diagnosed with moderate TR between January 2016 and July 2020. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and the composite of heart failure (HF) hospitalization plus tricuspid valve (TV) intervention. RESULTS After a median follow-up of 3.6 years, TR progression occurred in 84 patients (34%). At multivariate analyses, atrial fibrillation (AF, OR 1.81, CI 1.01-3.29, p = 0.045) and right ventricular end-diastolic diameter (RVEDD, OR 2.19, CI 1.26-3.78, p = 0.005) were independent predictors of TR progression. The primary endpoint occurred in 59 patients (24%) and was significantly more frequent in the group with TR progression (p = 0.009). At multivariate analyses, chronic kideney disease (OR 2.80, CI 1.30-6.03, p = 0.009), left ventricular ejection fraction (OR 0.97, CI 0.94-0.99, p = 0.041) and TR progression (OR 2.32, CI 1.31-4.12, p = 0.004) were independent predictors of the primary outcome. Moreover, both the secondary endpoints of CV death and HF hospitalization plus TV intervention were more frequent in the TR progression group (p = 0.001 and p < 0.001, respectively). CONCLUSIONS Moderate TR progresses in a significant proportion of patients over a long-term follow-up, leading to a worse prognosis. TR progression is an independent determinant of hard clinical events and AF and RVEDD are associated with TR progression.
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Affiliation(s)
- Davide Margonato
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy.
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Cesari
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Federico Biondi
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Martina Belli
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Claudio Montalto
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Camilla Manini
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
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