Background: Long-term outcomes of isolated significant tricuspid regurgitation (TR) without significant left-side heart disease remain to be clearly demonstrated.
Methods: We enrolled 547 consecutive patients (age: 64±14 years) with isolated significant TR. Initial clinical and echocardiographic characteristics and clinical outcomes were analyzed for 5.6±2.1 years.
Results: Survival rate was not different between 39 patients who underwent tricuspid valve (TV) surgery and 508 patients who did not (p=0.48). Of 508 patients without TV surgery, 32 patients (6.3%) died with cardiac cause during the follow-up period. Those patients were older (71±16 vs. 64±13 years, p<0.05) and showed initial larger TR jet area (15±7 vs. 12±4 cm2, p<0.05), and higher pulmonary artery systolic pressure (PASP, 46±22 vs. 39±16 mmHg, p<0.05). By adjusting other baseline characteristics using Cox proportional hazard model, age (HR; 1.045, 95% CI: 1.013–1.078), initial TR jet area (HR; 1.110, 95% CI; 1.061–1.160), and PASP (HR; 1.025, 95% CI; 1.009–1.042) were independent predictors of cardiac mortality. Mortality rates did not differ between patients with organic and functional TR. Initial TR jet area ≥12 cm2 and PASP ≥36 mmHg were best cut-off values for predicting cardiac mortality (Fig).
Conclusions: Severity of TR and pulmonary hypertension are prognostic factors independent of age in medically-managed patients with isolated significant TR. The results may suggest an optimal surgical timing in these patients.
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