Key result
Ischemic mitral regurgitation is linked to developing functional tricuspid regurgitation in ~30% of patients over 5 years.
Why the study?
Although functional tricuspid regurgitation is common in left-sided heart pathology involving the mitral valve, its incidence, clinical impact, risk factors, and natural history in the setting of ischemic mitral regurgitation are less known.
Cohort (n=134)
Functional tricuspid regurgitation develops in nearly one-third of patients with ischemic mitral regurgitation and almost universally progresses over 5 years, driven by worse LVEF, MR severity, RV dysfunction, and pulmonary hypertension.
Answers are grounded in this paper and cite their sources.
May warrant enhanced surveillance for tricuspid regurgitation in ischemic mitral regurgitation; leaves open whether early intervention alters progression.
Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was five years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N=40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7±9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3±6.45 [%], LA area 46.4±8.06 [mm2], LV internal diastolic diameter (LVIDD) 59.6±3.94 [mm], RV fractional area change (RVFAC) 22.3±4.36 [%], systolic pulmonary artery pressure (SPAP) 48.4±9.45 [mmHg]. Independent variables associated with FTR development were age ≥65y [OR 1.2], failed revascularization, LA area ≥42.5 [mm2] [OR 17.1], LVEF ≤24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p=0.06 and p=0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.
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Koren et al. (2021) conducted a cohort in Ischemic mitral regurgitation (IMR) (n=134). Ischemic mitral regurgitation and associated risk factors (LVEF ≤24%, moderate/severe MR, RV dysfunction, pulmonary hypertension) was evaluated on Functional tricuspid regurgitation (FTR) developing at any stage. Ischemic mitral regurgitation led to functional tricuspid regurgitation in 29.9% of patients over 5 years, with 97.5% experiencing progression.
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