Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem

Erin A. Fender, Ioana Petrescu, Filip Ionescu, Chad J. Zack, Sorin V. Pislaru, Vuyisile T. Nkomo, Jordan J. Cochuyt, David O. Hodge, Rick A. Nishimura

Research output: Contribution to journalArticle

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Abstract

Objective: To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival. Patients and Methods: We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50%, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality. Results: Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6% (204) were women, atrial fibrillation was present in 74.0% (214), and 24.6% (71) had an intracardiac device. By 5 years after diagnosis, 51.5% had been hospitalized for heart failure. Observed 5-year mortality was 47.8% compared with 36.3% in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95% CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95% CI, 1.16-2.8; P=.009) as associated with increased mortality. Conclusion: Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.

Original languageEnglish (US)
Pages (from-to)2032-2039
Number of pages8
JournalMayo Clinic Proceedings
Volume94
Issue number10
DOIs
StatePublished - Oct 2019

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Tricuspid Valve Insufficiency
Survival
Mortality
Censuses
Tricuspid Valve Stenosis
Heart Diseases
Heart Failure
Atrial Pressure
Carcinoid Tumor
Inferior Vena Cava
Ventricular Pressure
Rheumatic Diseases
Pulmonary Hypertension
Atrial Fibrillation
Echocardiography
Comorbidity
Creatinine
Cohort Studies
Retrospective Studies
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Fender, E. A., Petrescu, I., Ionescu, F., Zack, C. J., Pislaru, S. V., Nkomo, V. T., ... Nishimura, R. A. (2019). Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem. Mayo Clinic Proceedings, 94(10), 2032-2039. https://doi.org/10.1016/j.mayocp.2019.04.036
Fender, Erin A. ; Petrescu, Ioana ; Ionescu, Filip ; Zack, Chad J. ; Pislaru, Sorin V. ; Nkomo, Vuyisile T. ; Cochuyt, Jordan J. ; Hodge, David O. ; Nishimura, Rick A. / Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation : A Growing Problem. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 10. pp. 2032-2039.
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title = "Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem",
abstract = "Objective: To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival. Patients and Methods: We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50{\%}, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality. Results: Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6{\%} (204) were women, atrial fibrillation was present in 74.0{\%} (214), and 24.6{\%} (71) had an intracardiac device. By 5 years after diagnosis, 51.5{\%} had been hospitalized for heart failure. Observed 5-year mortality was 47.8{\%} compared with 36.3{\%} in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95{\%} CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95{\%} CI, 1.16-2.8; P=.009) as associated with increased mortality. Conclusion: Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.",
author = "Fender, {Erin A.} and Ioana Petrescu and Filip Ionescu and Zack, {Chad J.} and Pislaru, {Sorin V.} and Nkomo, {Vuyisile T.} and Cochuyt, {Jordan J.} and Hodge, {David O.} and Nishimura, {Rick A.}",
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Fender, EA, Petrescu, I, Ionescu, F, Zack, CJ, Pislaru, SV, Nkomo, VT, Cochuyt, JJ, Hodge, DO & Nishimura, RA 2019, 'Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation: A Growing Problem', Mayo Clinic Proceedings, vol. 94, no. 10, pp. 2032-2039. https://doi.org/10.1016/j.mayocp.2019.04.036

Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation : A Growing Problem. / Fender, Erin A.; Petrescu, Ioana; Ionescu, Filip; Zack, Chad J.; Pislaru, Sorin V.; Nkomo, Vuyisile T.; Cochuyt, Jordan J.; Hodge, David O.; Nishimura, Rick A.

In: Mayo Clinic Proceedings, Vol. 94, No. 10, 10.2019, p. 2032-2039.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic Importance and Predictors of Survival in Isolated Tricuspid Regurgitation

T2 - A Growing Problem

AU - Fender, Erin A.

AU - Petrescu, Ioana

AU - Ionescu, Filip

AU - Zack, Chad J.

AU - Pislaru, Sorin V.

AU - Nkomo, Vuyisile T.

AU - Cochuyt, Jordan J.

AU - Hodge, David O.

AU - Nishimura, Rick A.

PY - 2019/10

Y1 - 2019/10

N2 - Objective: To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival. Patients and Methods: We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50%, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality. Results: Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6% (204) were women, atrial fibrillation was present in 74.0% (214), and 24.6% (71) had an intracardiac device. By 5 years after diagnosis, 51.5% had been hospitalized for heart failure. Observed 5-year mortality was 47.8% compared with 36.3% in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95% CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95% CI, 1.16-2.8; P=.009) as associated with increased mortality. Conclusion: Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.

AB - Objective: To define mortality associated with isolated tricuspid regurgitation (TR) and identify risk factors associated with decreased survival. Patients and Methods: We conducted a retrospective cohort study of residents of southeastern Minnesota with moderate-severe or more severe isolated TR diagnosed between January 1, 2005, and April 15, 2015. Isolated TR was defined as TR in the absence of left-sided heart disease or pulmonary hypertension. Patients with an ejection fraction of less than 50%, right ventricular systolic pressure greater than 45 mm Hg, moderate or more severe left-sided valve disease, congenital cardiac anomalies, previous valve operation, tricuspid stenosis, flail leaflet, carcinoid, and rheumatic disease were excluded. Five-year survival was compared with age- and sex-matched Minnesota census bureau data. Multivariate regression was used to identify variables associated with mortality. Results: Over a 10-year period, 289 patients with isolated TR were identified. The mean ± SD age was 79.2±10.6 years, 70.6% (204) were women, atrial fibrillation was present in 74.0% (214), and 24.6% (71) had an intracardiac device. By 5 years after diagnosis, 51.5% had been hospitalized for heart failure. Observed 5-year mortality was 47.8% compared with 36.3% in the census data (P=.005). After adjusting for age and other comorbidities, multivariate regression identified a dilated inferior vena cava (≥2.1 cm) without respiratory variation on echocardiography (hazard ratio, 1.93; 95% CI, 1.13-3.31; P=.02) and creatinine level greater than 1.6 mg/dL (hazard ratio, 1.8; 95% CI, 1.16-2.8; P=.009) as associated with increased mortality. Conclusion: Patients with isolated TR are frequently hospitalized for heart failure and experience excess mortality. Elevated right atrial pressure and renal dysfunction are associated with mortality. This poor outcome may have implications for timing of intervention.

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