Document Detail

Tricuspid regurgitation in patients with severe mitral regurgitation and normal left ventricular ejection fraction: risk factors and prognostic implications in a cohort of 895 patients.
MedLine Citation:
PMID:  20845886     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: Although tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR), its frequency, determinants and prognostic implications in those with severe MR and a normal left ventricular ejection fraction (LVEF) are not fully known. The study aim was to evaluate the risk factors for, and prognostic implications of, TR in patients with severe MR and a normal LVEF. METHODS: In this retrospective cohort study, the authors' echocardiographic database for the period between 1993 and 2003 was screened for patients with severe MR and LVEF > or = 55%. Chart reviews were performed for clinical, pharmacological and surgical details, while survival was analyzed as a function of TR severity. RESULTS: Among 895 patients with severe MR and normal LVEF, 510 (57%) had grade > or = 2+ TR, while 219 (24%) had grade 3 or 4+ TR. Those patients with grade > or = 2+ TR were older (p < 0.0001), more likely to be female (p < 0.0001), and had a higher right ventricular systolic pressure (RVSP) (p < 0.0001). After adjusting for group differences (except for atrial fibrillation), grade > or = 2+ TR was associated with a higher mortality (relative risk 1.4, 95% confidence interval 1.1-1.8, p = 0.02). Mitral valve surgery was associated with a better survival in those with grade > or = 2+TR (p = 0.0003). CONCLUSION: Significant TR is a frequent occurrence in patients with severe MR and a normal LVEF, and is associated with older age, female gender, and a higher RVSP. TR is independently associated with a higher mortality, while mitral valve surgery seems to offer a survival benefit.
Padmini Varadarajan; Ramdas G Pai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-09-17     Completed Date:  2010-10-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  412-9     Citation Subset:  IM    
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
California / epidemiology
Cardiac Surgical Procedures* / adverse effects,  mortality
Chi-Square Distribution
Cohort Studies
Echocardiography, Doppler
Kaplan-Meiers Estimate
Logistic Models
Middle Aged
Mitral Valve Insufficiency / complications*,  diagnosis,  mortality,  physiopathology,  surgery
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Stroke Volume*
Time Factors
Treatment Outcome
Tricuspid Valve Insufficiency / diagnosis,  etiology*,  mortality,  physiopathology
Ventricular Function, Left*
Ventricular Function, Right
Ventricular Pressure

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