Prognostic implications of tricuspid regurgitation in patients with severe aortic regurgitation: results from a cohort of 756 patients

Tricuspid regurgitation (TR) is common, but neglected. We evaluated the prognostic implications of TR in a cohort of 756 patients with severe aortic regurgitation (AR). A cohort of 756 patients with AR was identified from our echocardiographic database. Chart reviews were performed. Survival as a function of TR severity was analysed. Of the 756 patients with severe AR, 264 (35%) had ≥ 2+ TR. Univariate correlates of TR were older age (P < 0.0001), female gender (P < 0.0001), lower left ventricular ejection fraction (P < 0.0001), atrial fibrillation (P < 0.0001), presence of a pacemaker (P < 0.0001), higher PASP (P < 0.0001), presence of 3 or 4+ mitral regurgitation (P < 0.0001) and not being on a beta-blocker (P < 0.0001) or statins (P = 0.007). After adjusting for group differences, ≥ 2+ TR was an independent predictor of higher mortality (RR 1.47, P = 0.005). Aortic valve replacement (AVR) was independently associated with improved survival in patients with ≥ 2+ TR. (RR 0.46, 95% CI 0.36-0.60, P < 0.0001). In conclusion, in severe AR patients, ≥ 2+ TR is independently associated with a higher mortality. The performance of AVR in these patients with ≥ 2+ TR is associated with a survival benefit. Development of ≥ 2+ TR in these patients is a marker of decompensation and should serve as an indication for AVR.