CMR-quantified tricuspid regurgitant fraction ≥50% was independently associated with increased all-cause mortality in patients with functional TR (AHR 2.60; 95% CI 1.45-4.66; p=0.001).
Cohort (n=547)
Does CMR-quantified tricuspid regurgitant volume and fraction predict all-cause mortality in patients with functional tricuspid regurgitation?
CMR-derived tricuspid regurgitation volume ≥45 ml or fraction ≥50% identifies patients with functional TR at the highest risk for all-cause mortality, providing potential thresholds for future intervention trials.
Effect estimate: AHR 1.26 (per 10% TRF increment) (95% CI 1.10-1.45)
p-value: p=0.001
BACKGROUND: Quantitation of tricuspid regurgitant (TR) severity can be challenging with conventional echocardiographic imaging and may be better evaluated using cardiovascular magnetic resonance (CMR). OBJECTIVES: In patients with functional TR, this study sought to examine the relationship between TR volume (TRVol) and TR fraction (TRF) with all-cause mortality. METHODS: We examined 547 patients with functional TR using CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. Thresholds for mild, moderate, and severe TR were derived based on natural history outcome data. RESULTS: During a median follow-up of 2.6 years (interquartile range: 1.7 to 3.3 years), there were 93 deaths, with an estimated 5-year survival of 79% (95% confidence interval CI: 73% to 83%). After adjustment of clinical and imaging variables, including RV function, both TRF (adjusted hazard ratio AHR per 10% increment: 1.26; 95% CI: 1.10 to 1.45; p = 0.001) and TRVol (AHR per 10-ml increment: 1.15; 95% CI: 1.04 to 1.26; p = 0.004) were associated with mortality. Patients in the highest-risk strata of TRVol ≥45 ml or TRF ≥50% had the worst prognosis (AHR: 2.26; 95% CI: 1.36 to 3.76; p = 0.002 for TRVol and AHR: 2.60; 95% CI: 1.45 to 4.66; p = 0.001 for TRF). CONCLUSIONS: This is the first study to use CMR to assess independent prognostic implications of functional TR. Both TRF and TRVol were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction. A TRVol of ≥45 ml or TRF of ≥50% identified patients in the highest-risk strata for mortality. These CMR thresholds should be used for patient selection in future trials to determine if tricuspid valve intervention improves outcomes in this high-risk group.
Zhan et al. (Tue,) conducted a cohort in functional tricuspid regurgitation (n=547). Cardiovascular magnetic resonance (CMR) quantification of TR volume and fraction was evaluated on all-cause mortality (AHR 1.26 (per 10% TRF increment), 95% CI 1.10-1.45, p=0.001). CMR-quantified tricuspid regurgitant fraction ≥50% was independently associated with increased all-cause mortality in patients with functional TR (AHR 2.60; 95% CI 1.45-4.66; p=0.001).