Abstract 12147: Tricuspid Regurgitation is Associated to Higher Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Low Ejection Fraction -Results From the TOPAS Study-
Background: Tricuspid regurgitation (TR) is a common finding in patients with low-flow low-gradient aortic stenosis (LF-LG AS) with reduced ejection fraction (EF). The objective of this study was to examine the impact of TR on mortality in this population of patients.
Methods: 215 patients (age=73±10 yr; 77% men) with LF-LG AS (mean gradient≤40 mmHg and indexed aortic valve area [AVA] ≤0.6 cm2/m2) with reduced EF (≤40%) were prospectively enrolled in the TOPAS study and 125 (58%) of these patients underwent an aortic valve replacement (AVR) within 3 months following inclusion. The severity of AS was assessed by the projected AVA (AVAproj) at normal flow rate (250 ml/s). The severity of TR was assessed in an Echocardiography Core laboratory and graded according to the guidelines of the American Society of Echocardiography.
Results: Among the 215 patients included in the study, 25 (12%) had moderate/severe TR and 50 (23%) mild TR. During a mean follow up of 2.4±2.2 years, 104 (48%) patients died. Two-year mortality rate was 28% in patients without TR, 44% in patients with mild TR, and 58% in patients with moderate/severe TR (p=0.005) (Figure). After adjustment for type of treatment (AVR vs. No AVR), presence of mild TR (HR=1.76; 95% CI 1.10-1.77; p=0.02) and moderate/severe TR (HR=2.34; 95% CI 1.27- 4.07; p=0.008) were significantly associated with an increased risk of all-cause mortality. After further adjustment for age, gender, coronary artery disease, AVAproj, EF, stroke volume index and systolic pulmonary arterial pressure, the presence of ≥ mild TR (HR=1.78; 95% CI 1.06-3.00; p=0.03) was an independent predictor of mortality.
Conclusion: In patients with low EF, LF-LG AS, TR is independently associated with increased risk of all-cause mortality. Further studies are needed to determine if TR is a risk marker or a risk factor for mortality and if surgical correction of TR at the time of AVR improves outcome in this high risk population.
- © 2013 by American Heart Association, Inc.