Development of significant tricuspid regurgitation over time and prognostic implications: new insights into natural history

Aims To evaluate the risk factors influencing the development of significant (moderate and severe) tricuspid regurgitation (TR), and its impact on all-cause mortality in Urge registry of referral centre. Methods and results In 1000 patients (mean age 68 +/- 13 years; 50.9% male) with documented significant TR, clinical, and echocardiographic data were retrospectively analysed when the echocardiogram showed none/mild TR. Patients with congenital heart disease were excluded. The study population was divided into quartiles according to the time interval between the two echocardiograms: Group 1: <= 1.2 years, n= 251; Group 2: 1.3-4.7 years, n= 248, Group 3: 4.88.9 years, n= 251; Group 4: >= 9.0 years, n= 250. Baseline age [odds ratio (OR) 1.02], presence of pacemaker and defibrillator lead (OR 1.59), presence of mild (vs. none) TR (OR 8.96), reduced tricuspid annulus plane systolic excursion (OR 0.86), and tricuspid annulus dilation (OR 1.06) were independently associated with development of significant TR in a short period of time. Any valvular surgery (without concomitant tricuspid surgery) occurring between both echocardiograms was also associated with a higher risk of fast development of significant TR (OR 1.58). During a median follow-up of 2.9 years after the second echocardiogram (with significant TR), 42.1% patients died. Patients with fast development of significant TR showed worse survival than patients with slower significant TR development (log rank P=0.001). Fast development of significant TR was independently associated with allcause mortality (hazard ratio per preceding year of development 0.92, confidence interval 0.90-0.94; P <0.001). Conclusion By identifying patients at increased risk of developing significant TR, close echocardiographic surveillance can be indicated permitting effective therapy at an earlier stage to improve survival.