Etiology of tricuspid regurgitation and mortality: a multicenter cohort study.

Manuel Jiménez-Navarro, David Couto-Mallón, Mario Gutiérrez-Bedmar, Jorge Rodríguez-Capitán, Mora Murri, Paloma Márquez-Camas, Jesús Carmona-Carmona, Diego Félix Arroyo Moñino, Marinela Chaparro-Muñoz, Matías Soler-González, Manuel García Del Río, Teodora Egido de la Iglesia, Jorge Segovia-Reyes, José Raúl López Salguero, Miguel Romero-Cuevas, Francisco Javier Pavón-Morón

Journal: Clinical research in cardiology : official journal of the German Cardiac Society 2025;114(7):915-926

PMID: 40338330

Free Full Text on PubMed Central View on PubMed

Abstract

BACKGROUND

Significant tricuspid regurgitation (TR) encompasses a wide range of etiologies, complicating a comprehensive understanding of disease progression and prognostic factors. This study aimed to assess mortality associated with significant TR, focusing on the role of valvular disease etiology and other predictive factors.

METHODS

This is a retrospective, multicenter, cohort observational study, including all consecutive patients with moderate-to-severe or greater TR. The patients were classified into five etiological groups: organic TR, TR secondary to left valvulopathy, TR secondary to left or right ventricular dysfunction, TR secondary to pulmonary hypertension, and atrial TR. The long-term mortality was assessed (median follow-up: 39.8 months).

RESULTS

757 patients were included. The overall mortality incidence rate was 162.5 deaths per 1000 patient-years. Compared to atrial TR, all other etiologies presented a higher mortality risk: organic TR adjusted hazard ratio (aHR) = 2.344 (95% confidence interval [CI]: 1.138-4.829), left valvulopathy-related TR aHR = 1.901 (95% CI: 1.011-3.574), ventricular dysfunction-related TR aHR = 3.683 (95% CI: 1.627-8.338), and pulmonary hypertension-related TR aHR = 2.446 (95% CI: 1.215-4.927). In addition to known factors, male sex was associated with a higher mortality risk (aHR = 1.608, 1.175-2.201), while beta-blocker use was linked to a lower risk (aHR = 0.674, 0.502-0.904).

CONCLUSIONS

In a large cohort of patients with significant TR, and after adjusting for clinical and echocardiographic variables, all etiological groups exhibited a higher mortality risk compared to atrial TR. Additionally, male patients with TR had a higher mortality risk, while beta-blocker therapy emerged as a protective factor.

Address: Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain.; Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain.; Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain.; Área Quirúrgica, Hospital De Antequera, Antequera, Spain.; Servicio de Cardiología, Hospital Punta de Europa, Algeciras, Spain.; IES Federico García Bernalt, Salamanca, Spain.; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain.; Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Endocrinolgy and Nutrition UCG, Hospital Universitario Virgen de La Victoria, Málaga, Spain.; Centro de Investigación Biomédica en Red en Fisiopatología de Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Cardiología, Hospital de Antequera, Antequera, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain. [email protected].; Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [email protected].; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain. [email protected].; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain. [email protected].; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain. [email protected].; Departmento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Málaga, Málaga, Spain. [email protected].; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain.; Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.; Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.

DOI: 10.1007/s00392-025-02662-z

Link outs

Free resources

Full Text Sources:

https://pmc.ncbi.nlm.nih.gov/articles/pmid/4033833...

Subscription / membership required

Full Text Sources:

https://dx.doi.org/10.1007/s00392-025-02662-z

MeSH Terms: Humans, Male, Female, Tricuspid Valve Insufficiency, Retrospective Studies, Aged, Middle Aged, Risk Factors, Prognosis, Incidence, Survival Rate, Follow-Up Studies, Severity of Illness Index, Echocardiography