Improvement of the Prognosis Assessment of Severe Tricuspid Regurgitation by the Use of a Five-Grade Classification of Severity
Section snippets
Methods
Between January 2013 and December 2018, 259 consecutive patients aged ≥18 years with a diagnosis of ≥ moderate-to-severe TR on echocardiography were identified and included in an electronic database.5 Three distinct etiologies of TR were identified: primary (organic) TR (including drug-induced valve diseases, rheumatic valvular disease, myxomatous disease, infective endocarditis, carcinoid syndrome, congenital heart disease, traumatic and post-iatrogenic), secondary (functional) TR (to
Results
The study population consisted of 259 patients: 114 with moderate-to-severe TR and 145 with severe TR. Interobserver reproducibility was good for the measurement of coaptation gap (r = 0.93; intraclass correlation coefficient = 0.96 [0.86 to 0.99]), and perfect for the determination of the laminar character of the TR flow (kappa = 1) and for the identification of an inverted hepatic vein flow (kappa = 1). In the 145 patients with severe TR, 52 met the definition of very severe TR with an
Discussion
The results of the present study show that very severe TR is common in patients with severe TR (36%), regardless of TR etiology, and corresponds to a more advanced stage of the disease with more RHF, larger RA and RV and more severe RV dysfunction. Our definition of very severe TR (grade 5), based on 3 simple reproducible anatomic and hemodynamic parameters, allows easy identification of a subgroup of patients with a high risk of events. Indeed, after adjustment for established outcome
Author contributions
The contribution of the authors is as follows:
Design of the study: Tribouilloy. Acquisition of data: All authors. Analysis and interpretation of data: Peugnet, Bohbot, Tribouilloy. Drafting of the manuscript: Peugnet, Bohbot, Tribouilloy. Critical revision for important intellectual content: all authors. Statistical analysis: Bohbot. Study supervision: Tribouilloy.
Disclosure
The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this paper.
Uncited Reference`
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FP and YB contributed equally to this work and are joint first authors.