Prognostic implications of staging right heart failure in patients with significant secondary tricuspid regurgitation

Abstract

OBJECTIVES The purpose of this study was to evaluate the prognostic value of staging right heart failure (RHF) in patients with significant secondary tricuspid regurgitation (TR).BACKGROUND Right ventricular dysfunction (RVD), defined as tricuspid annular plane systolic excursion <17 mm and clinical signs of RHF, defined as New York Heart Association functional class peripheral edema, or use of diuretics, do not always coincide in patients with significant secondary TR and may have different prognostic implications.METHODS A total of 1,311 patients with significant secondary TR (median age: 71 [interquartile range: 62 to 78] years; 50% mate) were divided into 4 RHF Stages according to the presence or absence of RVD and clinical signs of RHF: Stage 1 was defined as no RVD and no signs of RHF; Stage 2 indicated RVD but no signs of RHF; Stage 3 included RVD and signs of RHF; Stage 4 was defined as RVD and refractory signs of RHF at rest. Five-year mortality rates were compared across the 4 Stages of RHF, and the independent associates of mortality were identified by using multivariate Cox proportional hazards models.RESULTS A total of 101 patients (8%) were classified as Stage 1, 124 (10%) as Stage 2, 683 (52%) as Stage 3, and 403 (31%) as Stage 4. Patients in higher Stages of RHF had more comorbidities and worse renal and left ventricular systolic function. Cumulative 5-year survival was 54%. RHF Stages 3 and 4 were independently associated with increased mortality compared to Stage 1 (hazard ratio: 2.110 [95% confidence interval (CI): 1.163 to 3.828] and 3.318 [95% CI: 1.795 to 6.133], respectively).CONCLUSIONS In patients with significant secondary TR, higher Stages of RHF are independently associated with allcause mortality at long-term follow-up. (C) 2020 by the American College of Cardiology Foundation.