Prevalence, Burden and Echocardiographic Features of Moderate to Severe Tricuspid Regurgitation: Insights from a Tertiary Referral Center

Background : Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center. Methods : A retrospective analysis was performed on 6309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE). Results : A total of 2336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III-IV (p = 0.022) and on higher doses of loop diuretic (p = 0.022) than those with only moderate TR. Multivariable analysis revealed that blood urea nitrogen (BUN, p = 0.031) and abnormal liver function blood tests (p = 0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and tricuspid annular plane systolic excursion were found to be independent predictors of mid-term NACE. Conclusions : The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.