Clinical correlates and mortality of hemodynamically significant tricuspid regurgitation.

Background And Aim Of Study: Limited data exist regarding the etiologies and prognostic significance of severe tricuspid regurgitation (TR) in the modern medical era. This retrospective chart review examines the causes of, and mortality associated with, hemodynamically significant TR.

Methods: The database of the echocardiography laboratory at a major academic medical center was searched from August 2000 to October 2001, identifying 91 patients (1.2%) with transthoracic echocardiograms demonstrating moderate-severe or severe TR. A total of 77 available charts was reviewed retrospectively for medical history, examination and electrocardiogram findings. The underlying cause of each patient's TR was determined by compiling data from the chart and echocardiogram. All deaths were recorded from the date of echocardiography until September 2002.

Results: A cause for TR was determined in 96% of patients. Functional TR due to right ventricular pressure or volume overload was found in 85.5% of patients, while 14.5% had primary TR due to organic abnormalities of the tricuspid valve leaflets. Conditions associated with significant TR included pulmonary hypertension (46%), ischemic cardiomyopathy (25%), non-ischemic dilated cardiomyopathy (8%), Ebstein's anomaly (4%), rheumatic heart disease (4%), endocarditis (4%), tricuspid valve prolapse (2%), and severe mitral valve disease (2%). Of 37 patients (44.6%) who died, 17 (21%) did so within one month of the echocardiogram.

Conclusion: Among patients presenting to a tertiary medical center, hemodynamically significant TR was more commonly functional than due to organic tricuspid valve disease. The most frequently associated diseases included pulmonary hypertension and cardiomyopathy. Significant TR may be a marker of increased mortality risk as it reflects the severity of underlying disease. Further studies in this area are warranted.