Mild Tricuspid Regurgitation: A Marker of Disease Burden Independently Associated with Increased Mortality

Background: Tricuspid regurgitation (TR) is a common finding which appears to be associated with a worse prognosis. There are conflicting data regarding the prognostic impact of mild TR. We examined the clinical characteristics and echocardiographic properties of subjects with TR and its impact on clinical outcome with particular emphasis on subjects with mild TR. Methods: Consecutive echocardiography examinations during 5 years were evaluated for TR severity and outcome including mortality and cardiovascular hospitalizations. Results: The study included 21,429 subjects; 45% of the subjects had mild TR, 15% had moderate TR and 6.5% had severe TR. Primary organic TR was evident in 7% of the subjects, a percentage that increased with increasing TR severity. TR severity was incrementally associated with older subjects with an increasing number of comorbidities and echocardiographic abnormalities. 29% of the subjects died at a median follow-up duration of 8.7 years. Increasing severity of TR was independently and incrementally associated with mortality. Subjects with mild TR had a 25% increased mortality rate compared to subjects with minimal TR (HR 1.25, 95% CI 1.12-1.39, P<0.001) after adjustment for significant clinical parameters. TR severity was also an independent incrementally graded predictor of cardiovascular hospitalization and mortality (mild TR: HR 1.23, 95% CI 1.12-1.34, P<0.001). Conclusions: TR is associated with older and sicker patients with numerous comorbidities. TR severity is a predictor of a worse clinical outcome. Mild TR was independently associated with decreased survival. TR should be considered a marker of a disease burden with a poor prognosis.

Automated summary

This study examined the clinical characteristics and echocardiographic properties of subjects with tricuspid regurgitation (TR), with a specific focus on the impact of mild TR on clinical outcomes. The severity of TR was found to be associated with older age, comorbidities, and echocardiographic abnormalities. Increasing severity of TR was independently associated with mortality and cardiovascular hospitalizations, with mild TR independently associated with decreased survival. Therefore, TR should be considered as a marker of poor prognosis.