Quantitative assessment of tricuspid regurgitation by effective regurgitant orifice independently predicted decreased survival (adjusted HR 2.6; 95% CI 1.25-5.0; P=0.01 per 0.1 cm2 increment).
Cohort (n=676)
Does quantitative assessment of tricuspid regurgitation by effective regurgitant orifice measurement improve risk stratification for mortality compared to qualitative assessment in patients with all-cause TR?
Quantitative assessment of tricuspid regurgitation by effective regurgitant orifice is a powerful independent predictor of mortality, with optimal cut-offs of 0.35 cm2 for severe TR and 0.7 cm2 for torrential TR.
Effect estimate: HR 2.6 (95% CI 1.25-5.0)
p-value: p=0.01
Abstract Aims Asses the added value of quantitative evaluation of tricuspid regurgitation (TR), the proper cut-off value for severe TR and ‘torrential TR’ based on outcome data. The added value of quantitative evaluation of TR, and the cut-off values associated with increased mortality are unknown. Methods and results In patients with all-cause TR assessed both qualitatively and quantitatively by proximal iso-velocity surface area method, long-term and 1-year outcome analysis was conducted. Thresholds for excess mortality were assessed using spline curves, receiver-operating characteristic curves, and minimum P-value analysis. The study involved 676 patients with all-cause TR (age 73.9 ± 14 years, male 45%, ejection fraction 52.9 ± 14%). Effective regurgitant orifice (ERO) was strongly associated with decreased survival in unadjusted hazard ratio (HR) 2.38 (1.79–3.01), P 0.0001 per 0.1 cm2 increment and adjusted 2.6 (1.25–5.0), P = 0.01 analyses. Quantitative grading was superior to qualitative grading in prediction of outcome (P 0.01). The optimal cut-off value for the best separation in survival between groups of patients with severe vs. lesser degree of TR was 0.35 cm2 P 0.0001, HR =2.0 (1.5–2.7). ERO negatively impacted survival, even when including only the subgroup of patients with severe TR HR 1.5 (1.01–2.3); P = 0.04. The optimal threshold corresponding for the best separation for survival between groups of patients with severe vs. ‘torrential’ TR was 0.7 cm2 P = 0.005, HR =2.6 (1.2–5.1). Conclusion TR can be severe and even ‘torrential’ and is associated with excess mortality. Quantitative assessment of TR by ERO measurement is a powerful independent predictor of outcome, superior to standard qualitative assessment. The optimal cut-off above which mortality is increased is 0.35 cm2, similar albeit slightly lower than suggested in recent guidelines. Torrential TR 0.7 cm2 is associated with poorer survival compared to patients with severe TR (ERO 0.4 cm2 and 0.7 cm2).
Peri et al. (Sat,) conducted a cohort in Tricuspid regurgitation (n=676). Quantitative assessment of effective regurgitant orifice (ERO) vs. Qualitative assessment was evaluated on Survival (HR 2.6, 95% CI 1.25-5.0, p=0.01). Quantitative assessment of tricuspid regurgitation by effective regurgitant orifice independently predicted decreased survival (adjusted HR 2.6; 95% CI 1.25-5.0; P=0.01 per 0.1 cm2 increment).
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