Author + information
- Received June 11, 2020
- Revision received July 10, 2020
- Accepted July 13, 2020
- Published online September 7, 2020.
- Yang Zhan, MDa,b,
- Dany Debs, MDa,
- Mohammad A. Khan, MDa,
- Duc T. Nguyen, MD, PhDc,
- Edward A. Graviss, PhD, MPHc,d,
- Shaden Khalaf, MDa,
- Stephen H. Little, MDa,
- Michael J. Reardon, MDa,
- Sherif Nagueh, MDa,
- Miguel A. Quiñones, MDa,
- Neal Kleiman, MDa,
- William A. Zoghbi, MDa and
- Dipan J. Shah, MDa,∗ (, )@dipanjshah
- aDepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- bDepartment of Cardiology, Regina General Hospital, University of Saskatchewan, Regina, Saskatchewan, Canada
- cDepartment of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
- dDepartment of Surgery, Houston Methodist Hospital, Houston, Texas
- ↵∗Address for correspondence:
Dr. Dipan J. Shah, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, Suite 1801, Houston, Texas 77030.
Background Quantitation of tricuspid regurgitant (TR) severity can be challenging with conventional echocardiographic imaging and may be better evaluated using cardiovascular magnetic resonance (CMR).
Objectives In patients with functional TR, this study sought to examine the relationship between TR volume (TRVol) and TR fraction (TRF) with all-cause mortality.
Methods We examined 547 patients with functional TR using CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. Thresholds for mild, moderate, and severe TR were derived based on natural history outcome data.
Results During a median follow-up of 2.6 years (interquartile range: 1.7 to 3.3 years), there were 93 deaths, with an estimated 5-year survival of 79% (95% confidence interval [CI]: 73% to 83%). After adjustment of clinical and imaging variables, including RV function, both TRF (adjusted hazard ratio [AHR] per 10% increment: 1.26; 95% CI: 1.10 to 1.45; p = 0.001) and TRVol (AHR per 10-ml increment: 1.15; 95% CI: 1.04 to 1.26; p = 0.004) were associated with mortality. Patients in the highest-risk strata of TRVol ≥45 ml or TRF ≥50% had the worst prognosis (AHR: 2.26; 95% CI: 1.36 to 3.76; p = 0.002 for TRVol and AHR: 2.60; 95% CI: 1.45 to 4.66; p = 0.001 for TRF).
Conclusions This is the first study to use CMR to assess independent prognostic implications of functional TR. Both TRF and TRVol were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction. A TRVol of ≥45 ml or TRF of ≥50% identified patients in the highest-risk strata for mortality. These CMR thresholds should be used for patient selection in future trials to determine if tricuspid valve intervention improves outcomes in this high-risk group.
Dr. Shah has received support from the National Science Foundation (CNS-1931884) and the Beverly B. and Daniel C. Arnold Distinguished Centennial Chair Endowment. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received June 11, 2020.
- Revision received July 10, 2020.
- Accepted July 13, 2020.
- 2020 American College of Cardiology Foundation
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