Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease

M. M. C. Caldas; W. A. M. Esteves; B. R. Nascimento; J. Hung; R. Levine; V. R. Silva; M. L. Castro; L. M. T. Chavez; J. L. P. D. Silva; L. A. Mello; F. C. Ruffo; A. B. Andrade; Timothy Tan; L. G. Passaglia; C. M. V. Freire; M. C. P. Nunes

Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease

M. M. C. Caldas, W. A. M. Esteves, B. R. Nascimento, J. Hung, R. Levine, V. R. Silva, M. L. Castro, L. M. T. Chavez, J. L. P. D. Silva, L. A. Mello, F. C. Ruffo, A. B. Andrade, Timothy Tan, L. G. Passaglia, C. M. V. Freire, M. C. P. Nunes

Western Sydney University

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Objective A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD. Methods A total of 645 patients with RHD were enrolled, mean age of 47±12 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks. Results Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95% CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95% CI 1.34 to 2.17), New York Heart Association functional class III/IV (HR 2.57, 95% CI 1.54 to 4.30), right atrial area (HR 1.52, 95% CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95% CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated. Conclusions In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.

Original language	English
Article number	e002295
Number of pages	11
Journal	Open Heart
Volume	10
Issue number	2
Publication status	Published - 1 Sept 2023

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Keywords

echocardiography
mitral valve stenosis
tricuspid valve insufficiency

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Cite this

Caldas, M. M. C., Esteves, W. A. M., Nascimento, B. R., Hung, J., Levine, R., Silva, V. R., Castro, M. L., Chavez, L. M. T., Silva, J. L. P. D., Mello, L. A., Ruffo, F. C., Andrade, A. B., Tan, T., Passaglia, L. G., Freire, C. M. V., & Nunes, M. C. P. (2023). Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease. Open Heart, 10(2), Article e002295.

@article{acb970f254fb4bfaaf64f6407e70f779,

title = "Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease",

abstract = "Objective A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD. Methods A total of 645 patients with RHD were enrolled, mean age of 47±12 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks. Results Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95% CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95% CI 1.34 to 2.17), New York Heart Association functional class III/IV (HR 2.57, 95% CI 1.54 to 4.30), right atrial area (HR 1.52, 95% CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95% CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated. Conclusions In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.",

keywords = "echocardiography, mitral valve stenosis, tricuspid valve insufficiency",

author = "Caldas, {M. M. C.} and Esteves, {W. A. M.} and Nascimento, {B. R.} and J. Hung and R. Levine and Silva, {V. R.} and Castro, {M. L.} and Chavez, {L. M. T.} and Silva, {J. L. P. D.} and Mello, {L. A.} and Ruffo, {F. C.} and Andrade, {A. B.} and Timothy Tan and Passaglia, {L. G.} and Freire, {C. M. V.} and Nunes, {M. C. P.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = sep,

day = "1",

language = "English",

volume = "10",

journal = "Open Heart",

issn = "2053-3624",

publisher = "BMJ Group",

number = "2",

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TY - JOUR

T1 - Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease

AU - Caldas, M. M. C.

AU - Esteves, W. A. M.

AU - Nascimento, B. R.

AU - Hung, J.

AU - Levine, R.

AU - Silva, V. R.

AU - Castro, M. L.

AU - Chavez, L. M. T.

AU - Silva, J. L. P. D.

AU - Mello, L. A.

AU - Ruffo, F. C.

AU - Andrade, A. B.

AU - Tan, Timothy

AU - Passaglia, L. G.

AU - Freire, C. M. V.

AU - Nunes, M. C. P.

PY - 2023/9/1

Y1 - 2023/9/1

N2 - Objective A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD. Methods A total of 645 patients with RHD were enrolled, mean age of 47±12 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks. Results Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95% CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95% CI 1.34 to 2.17), New York Heart Association functional class III/IV (HR 2.57, 95% CI 1.54 to 4.30), right atrial area (HR 1.52, 95% CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95% CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated. Conclusions In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.

AB - Objective A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD. Methods A total of 645 patients with RHD were enrolled, mean age of 47±12 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks. Results Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95% CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95% CI 1.34 to 2.17), New York Heart Association functional class III/IV (HR 2.57, 95% CI 1.54 to 4.30), right atrial area (HR 1.52, 95% CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95% CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated. Conclusions In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.

KW - echocardiography

KW - mitral valve stenosis

KW - tricuspid valve insufficiency

UR - https://hdl.handle.net/1959.7/uws:73069

UR - http://www.scopus.com/inward/record.url?scp=85170701476&partnerID=8YFLogxK

M3 - Article

SN - 2053-3624

VL - 10

JO - Open Heart

JF - Open Heart

IS - 2

M1 - e002295

ER -

Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease

Abstract

Bibliographical note

Open Access - Access Right Statement

Keywords

UN SDGs

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