Clinical Characteristics, Outcomes, and Risk Stratification of Combined Mitral and Tricuspid Regurgitation

Figures

• 

  Figure 1. Flowchart of the Study Cohort From China-VHD Study A total of 6,704 adult patients with ≥ moderate mitral regurgitation (MR) or tricuspid regurgitation (TR) from the China-VHD (China Valvular Heart Disease) study were included in this analysis. Of the total study cohort from the China-VHD study, 1,805, 2,943, and 1,956 patients had combined MR and TR, isolated MR, and isolated TR, respectively. AR = aortic regurgitation; AS = aortic stenosis; MS = mitral stenosis; TS = tricuspid stenosis.

• 

  Figure 2. Kaplan-Meier Curves According to Types of VHD (A) The Kaplan-Meier curve of survival according to types of valvular heart disease (VHD) in the total cohort. (B) The Kaplan-Meier curve of event-free survival according to types of VHD in the total cohort. (C) The Kaplan-Meier curve of survival according to types of VHD in the medically treated cohort. (D) The Kaplan-Meier curve of event-free survival according to types of VHD in the medically treated cohort. Abbreviations as in Figure 1.

• 

  Figure 3. Subgroup Analyses for All-Cause Mortality Adjusted for age, sex, body mass index, smoking status, hypertension, hyperlipidemia, diabetes, coronary artery disease, cardiomyopathy, atrial fibrillation or flutter, chronic lung disease, chronic kidney disease, NYHA functional class (which was not adjusted in analyses divided by NYHA functional class), estimated glomerular filtration rate, hemoglobin, albumin, total bilirubin, left atrial end-diastolic dimension, left ventricular end-diastolic dimension, left ventricular ejection fraction (LVEF), pulmonary hypertension, and severity of VHD (which was not adjusted in analyses divided by severity of VHD). ∗The P values for interaction were reported across subgroups of patients. Abbreviations as in Figures 1 and 2.

• 

  Figure 4. Temporal Changes of Functional Status During 2-Year Follow-Up (A) The alluvial plot in total cohort. (B) The alluvial plot in patient with combined mitral regurgitation and tricuspid regurgitation. (C) The alluvial plot in patient with isolated mitral regurgitation. (D) The alluvial plot in patient with isolated tricuspid regurgitation.

• 

  Figure 5. The CoMT Nomogram The value of each prognostic factor was assigned a point by drawing a perpendicular line to the “Points” scale. The sum of the points of all prognostic factors was plotted on the “Total points” scale, and the total point corresponded to the mortality risk at the bottom. CKD = chronic kidney disease; CoMT = combined mitral and tricuspid regurgitation; eGFR = estimated glomerular filtration rate; LVEDD = left atrial end-diastolic dimension; MVI = mitral valve intervention.

• 

  Figure 6. Restricted Cubic Splines for the Associations of Variables With Mortality The restricted cubic splines were constructed with 3 default knots at 10th, 50th, and 90th percentiles. The risks corresponding to the median values of variables were selected as references. (A) The restricted cubic spline for the association of hemoglobin with mortality. (B) The restricted cubic spline for the association of eGFR with mortality. (C) The restricted cubic spline for the association of albumin with mortality. (D) The restricted cubic spline for the association of LVEDD with mortality. (E) The restricted cubic spline for the association of CoMT score with mortality in the derivation cohort. (F) The restricted cubic spline for the association of CoMT score with mortality in the validation cohort. Abbreviations as in Figure 5.

• 

  Central Illustration. Characteristics, Outcomes, and Risk Stratification of Combined Mitral Regurgitation and Tricuspid Regurgitation (A) The China-VHD (China Valvular Heart Disease) cohort was the primary study cohort, which included 6,704 patients. Patients with both MR and TR (n = 1,805) in the China-VHD cohort were used as the derivation cohort of the CoMT model. Patients in the China-DVD (China Elderly Valve Disease) cohort with complete data on predictors in the CoMT model (n = 1,132) were used as the validation cohort. (B) The study outcomes included all-cause mortality and hospitalization for heart failure within 2 years. The Kaplan-Meier curves showed the survival and event-free survival according to types of VHD in the China-VHD cohort. (C) The CoMT score and the shape of the relationship between CoMT score and all-cause mortality in the derivation cohort. CoMT = combined mitral and tricuspid regurgitation; eGFR = estimated glomerular filtration rate; LVEDD = left ventricular end-diastolic dimension; MR = mitral regurgitation; TR = tricuspid regurgitation.