Improvement of the Prognosis Assessment of Severe Tricuspid Regurgitation by the Use of a Five-Grade Classification of Severity
Key result
Very severe TR linked to ~143% greater risk of RHF and CV death vs moderate-to-severe TR.
- HR 2.43
- 95% CI 1.18-5.53
- P=0.002
- n=259
Why the study?
The prognosis of patients with very severe tricuspid regurgitation defined by specific echocardiographic parameters was not well characterized.
Does a 5-grade classification identifying 'very severe' tricuspid regurgitation predict worse prognosis compared to moderate-to-severe or severe tricuspid regurgitation?
Population
259 consecutive patients with moderate-to-severe and severe tricuspid regurgitation
Comparison
Very severe TR vs severe TR vs moderate-to-severe TR
Design
Cohort study
Follow-up
Median 24 months (7 to 47) months
Authors
Discussion
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Member takes
Implication
Defining very severe TR may refine prognosis in advanced cases; leaves open whether this grading improves risk stratification or management.
Study Design
Type
Cohort (n=259)
Structured PICO
Does a 5-grade classification identifying 'very severe' tricuspid regurgitation predict worse prognosis compared to moderate-to-severe or severe tricuspid regurgitation?
P
Population
259 consecutive patients (mean age 76 years, 54% female) with moderate-to-severe or severe tricuspid regurgitation, followed for a median of 24 months.
E
Exposure
Classification as 'very severe' tricuspid regurgitation (defined by coaptation gap ≥10mm, laminar TR flow, and systolic reversal of hepatic vein flow)
C
Comparator
Moderate-to-severe tricuspid regurgitation and severe tricuspid regurgitation (not meeting very severe criteria)
O
Outcome
Combination of hospitalisation for right heart failure (RHF) and cardiovascular mortalitycomposite
Main Result
Hazard Ratio: 2.43 (95% CI 1.18–5.53)
Absolute Event Rate: 35% vs 68%
p-value: p=0.002
Identifying 'very severe' tricuspid regurgitation using specific echocardiographic parameters defines a subgroup with significantly worse clinical outcomes, supporting the use of a 5-grade classification system.
Cite This Study
Peugnet et al. (2020) conducted a cohort in Tricuspid regurgitation (n=259). Very severe tricuspid regurgitation vs. Moderate-to-severe tricuspid regurgitation was evaluated on Combination of hospitalisation for right heart failure (RHF) and cardiovascular mortality (HR 2.43, 95% CI 1.18-5.53, p=0.002). Very severe tricuspid regurgitation was associated with a significantly worse prognosis compared to moderate-to-severe TR (adjusted HR 2.43; 95% CI 1.18-5.53; p=0.002).