Effect of Right Ventricular Function and Systolic Pressure on Survival of Patients with Tricuspid Regurgitation

Severe tricuspid regurgitation (TR) is associated with poor outcome. The current analysis investigated the effect of right ventricular dysfunction and right ventricular systolic pressure (RVSP) on the outcome patients with TR in the largest cardiovascular registry in Israel. Methods: SHARE (Sheba HeArt RegistEry) is an historical retrospective cohort of all patients evaluated at Leviev Heart Center between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. TR severity and RV function were extracted for all patients from the echocardiographic reports, RVSP information was available for 78,247 (80%) patients. All-cause mortality and was available for all patients from the Israeli Population Register. Results: Final cohort included 97,561 subjects, of whom 42,187 (43%) patients were outpatients. Mean age was 66±17 and 55,976 (57%) were men. Mild, moderate and severe TR was documented in 27,389(28%), 2,871(3%) and 1812 (2%) patients, respectively. During median follow up of 50 months [IQR 22-83] 18,476 (19%) patients died of whom 959 (5%) had severe TR. Among severe TR patients median RVSP was 56 (IQR of 46-66) with 9% patients with RVSP below 40 mmHg. RV dysfunction was documented as mild moderate and severe among 353(19%) 341(19%) and 266(15%) of the severe TR patients. Interaction analysis demonstrated that the association of severe TR with survival was dependent on RV dysfunction and RVSP such that the association was more pronounced among patients with severe RV dysfunction (HR of 1.38 [1.07-1.80] vs. 1.09 [1.00-1.19], p for interaction 0.01) and among patients with estimated RVSP < 40 mmHg (HR of 1.60 [1.21-2.11] vs. 1.14 [1.03-1.25], p for interaction < 0.001; FIGURE). Conclusions: The association of severe TR with overall survival is strongly dependent on RV dysfunction and estimated RVSP with higher risk of death among patients with RV dysfunction or low RVSP.