Abstract 17564: Tricuspid Regurgitation Adversely Impact Survival in Severe Aortic Regurgitation Patients: Results From a Cohort of 756 Patients and Implications for Surgical Management
Hypothesis: Prognostic implications and biological determinants of tricuspid regurgitation (TR) in patients with severe aortic regurgitation (AR) are not known. We hypothesized that TR has a negative impact on survival in patients with severe AR and this was tested in a cohort of 756 patients.
Methods: A cohort 756 consecutive patients with severe AR was identified from our echocardiographic database. Chart reviews were performed for clinical, pharmacological and surgical details. Mortality data was obtained from National Death Index. Survival was analyzed as a function of TR severity.
Results: Of the 756 patients with severe AR, 264 (35%) had ≥2+TR. The presence of TR was associated with older age (p<0.0001), female gender (p<0.0001), lower EF (p<0.0001), lesser LV wall thickness (p<0.0001), atrial fibrillation (p<0.0001), higher pulmonary artery pressure (p<0.0001) and not being on a beta blocker (p<0.0001) or a statin (p=0.007). After adjusting for group differences, ≥2+ TR was an independent predictor of higher mortality (figure, RR 1.35, p=0.02). Aortic valve replacement (AVR) was associated with improved survival in patients with ≥2+ TR in the presence of severe AR irrespective of tricuspid annuloplasty (RR 0.46, 95% CI 0.36–0.60, p <0.0001).
Conclusions: In severe AR patients, ≥2+ TR is common and is associated a higher mortality. Performance of AVR in severe AR patients with ≥2+ TR confers a survival benefit. Development of ≥2+ TR in severe AR patients seems to be a marker of decompensation and should serve as an indication for AVR.
- © 2010 by American Heart Association, Inc.