Valvular Heart Disease
Andrada C. Guta, MD, PhD
Postdoctoral research fellow
Houston Methodist DeBakey Heart & Vascular Center
Houston, Texas, United States
Andrada C. Guta, MD, PhD
Postdoctoral research fellow
Houston Methodist DeBakey Heart & Vascular Center
Houston, Texas, United States
Fatima Qamar, MD, MPH
Postdoctoral research fellow
Houston Methodist DeBakey Heart & Vascular Center, United States
Duc T. Nguyen, MD
ACDM Senior research associate
Houston Methodist DeBakey Heart & Vascular Center, United States
Edward A. Graviss, PhD, MPH
Scientist
Houston Methodist DeBakey Heart & Vascular Center, Texas, United States
Dipan J. Shah, MD
Chief, Division of Cardiovascular Imaging
Houston Methodist DeBakey Heart & Vascular Center
Houston, Texas, United States
Significant functional tricuspid regurgitation (FTR) is highly prevalent and is associated with increased cardiovascular mortality. Beyond FTR severity, it is unclear if measures of right ventricular (RV) remodeling add further to association with excess mortality. Cardiac magnetic resonance (CMR) is the ideal modality to assess RV remodeling. The aim of this study was to evaluate the relationship between RV remodeling and cardiovascular mortality in patients with significant FTR.
Methods:
A total of 1,076 patients with ≥ moderate FTR by CMR were comprehensively analyzed and followed for outcomes.
Results: Patients were followed for 3.2 +/- 2.6 years and 105 deaths were registered in the cohort, with an estimated 5-year survival of 81.7%. Tricuspid regurgitant volume (TRVol) and fraction (TRF) were associated with increased cardiovascular mortality and remained significant after serial progressive adjustments for age, clinical, and imaging variables: adjusted hazard ratio (AHR) [95% confidence interval (CI)] per 10-ml increment in TRVol 1.25 (1.09, 1.43), p< 0.001 and AHR (95% CI) per 10% increment in TRF 1.43 (1.18, 1.73), p< 0.001. While RV end-diastolic volume was not associated with excess cardiovascular mortality, RV ejection fraction (EF) was an independent factor with an optimal threshold for RV EF of 47% (AUC 0.65) identifying patients at the highest risk in this cohort.
Conclusion: In patients with significant FTR, an RV EF threshold of less than 47% is associated with increased cardiovascular mortality. Further study is needed to determine if this threshold of RV dysfunction could represent a trigger for tricuspid valve intervention.