Clinical InvestigationsTricuspid Regurgitation and OutcomesAdverse Prognostic Impact of Even Mild or Moderate Tricuspid Regurgitation: Insights from the National Echocardiography Database of Australia
Section snippets
Study Setting and Design
As described elsewhere,19 the NEDA database is a large observational registry capturing individual echocardiographic data, as well as basic demographic profiling, from over 25 participating centers throughout Australia. Centers include a range of public and private hospitals and inpatient and outpatient echocardiography laboratories and are situated in both urban and rural settings across the entire country. Individuals are referred by primary care physicians or cardiologists to investigate
Cohort Profile
In our final analysis cohort of 439,558 individuals, the mean age was 62.1 ± 17.8 years and the cohort included 213,186 (48.5%) women. Basic demographic, clinical, and echocardiographic data of the patient cohort are summarized in Table 1. No/trivial TR was reported in 311,604 (70.9%; 95% CI, 70.1%-71%) cases. Mild TR was reported in 94,172 (21.4%; 95% CI, 21.3%-21.5%), moderate TR in 26,056 (5.9%; 95% CI, 5.8%-6.0%), and severe TR in 7,726 (1.8%; 95% CI, 1.7%-1.8%), for a combined total of
Discussion
In this very large study of adults undergoing echocardiography, we found that TR in mild or greater degree was not only common (nearly one-third of the studied cohort had mild or greater TR) but that there was also a significant and graded association between the severity of TR and the risk of mortality. Even mild TR had independent prognostic significance. With more than 12 times as many identified cases of significant TR compared with any previous report, this study provides a unique
Conclusion
The scale of the NEDA database provides a unique opportunity to evaluate both the prevalence and the prognostic significance of TR in a very large cohort of adults undergoing cardiac investigation with echocardiography. We demonstrate that not only is moderate or greater TR prevalent (7.7% of individuals in our real world cohort) but that there is a significant stepwise increase in both short- and long-term mortality with increasing severity of TR. Even mild TR has independent prognostic
Acknowledgments
We thank all the NEDA centers and their patients for contributing to these data.
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Conflicts of Interest: None.
The National Echocardiography Database of Australia (NEDA) was originally established with funding support from Actelion Pharmaceuticals, Bayer Pharmaceuticals, GlaxoSmithKline. NEDA (no. 1055214) and S.S. are (GNT1135894) supported by the National Health and Medical Research Council of Australia. NEDA has received grants from Edwards Lifesciences, but they do not relate to the current manuscript.