Journal of the American Society of Echocardiography
Clinical InvestigationEchocardiography in Valvular Heart DiseasesRefining Severe Tricuspid Regurgitation Definition by Echocardiography with a New Outcomes-Based “Massive” Grade
Section snippets
Patient Population and Study Design
This retrospective study was approved by the Institutional Review Board with a waiver of consent. From our database of patients who were referred for a clinically indicated cardiac ultrasound examinations from January 2010 to January 2018, we identified 284 patients diagnosed with severe TR, defined as a VC ≥ 0.7 cm, in either the RV inflow or apical four-chamber views. The presence of severe TR was confirmed by remeasuring VC (K.Y.K., R.M.L.) in both views. The average VC was used, and in
Results
In the study cohort, the median age was 72.5 years (interquartile range, 59.5-84.75); the majority were female (73%), and there was a high prevalence of atrial fibrillation (47%). The K-partition algorithm yielded a partition value of VC ≤ 0.92 cm to define the severe TR group (n = 79; Figure 2A) and >0.92 cm to define the massive TR group (n = 43; Figure 2B) for a survival probability of P = .043 (Figure 3A). There were no significant differences in baseline demographics between these two
Discussion
The goal of this study was to refine the definition of severe TR based on mortality data, so that this definition could be used in device trials in order to select patients who may derive the most benefit from these emerging therapies and to assess improvement postintervention. The additional VC partition value of 0.92 cm was derived in the study cohort and subsequently tested in a separate validation cohort. Our study not only showed worse survival with a higher degree of massive TR but also
Conclusion
Patients with severe TR defined by current guidelines are not a homogenous population in terms of TR severity or potential outcomes. Within the group of patients with VC ≥ 0.7 cm, currently defined as having severe TR, there are varying degrees of severity and coexisting RV remodeling. When these patients are divided by a VC of 0.92 cm, two distinct categories can be appreciated that have divergent outcomes. The ability to distinguish patients with severe TR at particularly high risk may be
Acknowledgments
We thank Nicole Bell for her help with data management.
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Cited by (0)
Philippe Pibarot, DVM, PhD, served as guest editor for this report.
Conflicts of Interest: None.