What is the clinical evidence from this study?

Study design: Observational. Population: Acute Heart Failure (n=1842). Intervention: Severe tricuspid regurgitation (Grade 4) vs. No tricuspid regurgitation or mild (Grade 1). Primary outcome: 1-year all-cause mortality (HR 2.87, 95% CI 1.61-5.09, p=<0.001).

January 1, 2015Open Access

Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure

Q: What are the key findings of this study?

In patients with acute heart failure and preserved ejection fraction (LVEF ≥50%), severe tricuspid regurgitation was associated with a significantly increased risk of 1-year all-cause mortality (HR 2.87).

Key Result

In patients with acute heart failure and preserved ejection fraction (LVEF ≥50%), severe tricuspid regurgitation was associated with a significantly increased risk of 1-year all-cause mortality (HR 2.87).

Study Design

Type

Observational (n=1,842)

Multicenter

Structured PICO

Does tricuspid regurgitation severity predict 1-year all-cause mortality in patients with acute heart failure?

Population

1,842 consecutive patients admitted for acute heart failure (AHF), mean age 72.8 years, 51% female, 45.5% had LVEF <50%.

Intervention

Tricuspid regurgitation (TR) severity (graded non-TR, mild, moderate, moderate-severe, severe)

Comparator

No TR or mild TR (grade 1)

Outcome

1-year all-cause mortalityhard clinical

Tricuspid regurgitation severity is a significant predictor of 1-year mortality in acute heart failure patients with LVEF ≥50%, but not in those with LVEF <50%.

Main Result

Effect estimate: HR 2.87 (95% CI 1.61-5.09)

p-value: p=<0.001

Limitations

Single-center observational study with potential for hidden bias and unmeasured confounders
TAPSE was not available in every patient
NT-proBNP and other biomarkers were not obtained simultaneously to the echocardiographic data
Left-sided mitral and aortic regurgitation severities were not uniformly collected
Echocardiograms were not reviewed by an independent core laboratory external to the investigators

Abstract

BACKGROUND: Tricuspid regurgitation (TR) is a common echocardiographic finding that has been related to adverse outcome under various clinical scenarios. Nevertheless, evidence supporting its prognostic value in heart failure (HF) is scarce, and, in most cases, contradictory. We evaluated the association of TR grade with 1-year all-cause mortality in acute HF (AHF). METHODS AND RESULTS: We included 1,842 consecutive patients admitted for AHF. Mean age was 72.8±11.3 years, 51% were female and 45.5% had LVEF <50%. The severity of TR was graded in non-TR, mild (1), moderate (2), moderate-severe (3) and severe (4). At 1-year follow-up, 370 patients (20.1%) had died. In patients with LVEF ≥50%, a significant and positive association between TR severity and mortality was noted. Indeed, the HR for mortality for TR 3 and 4 vs. no TR/TR 1 were as follows: hazard ratios (HR), 1.68; 95% confidence intervals (95% CI): 1.08-2.60, P=0.02; and HR, 2.87; 95% CI: 1.61-5.09, P<0.001, respectively. In contrast, no association between TR grade and mortality (P=0.650) was observed in patients with LVEF <50% (P-value for interaction=0.033). CONCLUSIONS: A differential prognostic effect of TR severity on 1-year mortality was observed for LVEF HF status. The association was significant only in patients with LVEF ≥50%, with increasing mortality risk as TR became more severe.

Bookmark

View Full Paper