Choroba zastawki trójdzielnej – Rokowania, prognozy i postęp choroby

Choroba zastawki trójdzielnej
Rokowania, prognozy i postęp choroby

Choroba zastawki trójdzielnej, głównie niedomykalność (TR), jest istotnym problemem klinicznym o częstości występowania ≥0,55% w populacji ogólnej i do 7,2% u osób ≥65 lat. Niedomykalność trójdzielna wiąże się z 2,5-krotnie wyższym ryzykiem zgonu, a nawet umiarkowana TR zwiększa śmiertelność o 15%. Ciężka i umiarkowana TR, zarówno pierwotna, jak i wtórna, podwajają ryzyko zgonu i hospitalizacji z powodu niewydolności serca. Nadciśnienie płucne (PH) jest silnym niezależnym predyktorem śmiertelności (HR 2,22; 95% CI 1,41–3,47; p=0,001), przewyższającym stopień niedomykalności. Progresja funkcjonalnej TR jest częsta (34,3% w 10 lat) i związana z wiekiem, klasą NYHA III/IV, powiększeniem prawego przedsionka oraz dysfunkcją prawej komory (HR do 2,57). Dysfunkcja prawej komory oceniana TAPSE i FAC koreluje z gorszym rokowaniem, a przedsionkowa TR ma lepsze prognozy niż komorowa.

Wprowadzenie do choroby zastawki trójdzielnej
Prognostyczne znaczenie niedomykalności zastawki trójdzielnej

Wpływ stopnia niedomykalności na rokowanie
Niedomykalność zastawki trójdzielnej w kontekscie innych chorób serca

Czynniki prognostyczne w chorobie zastawki trójdzielnej

Nadciśnienie płucne jako kluczowy czynnik prognostyczny
Progresja niedomykalności zastawki trójdzielnej
Etiologia niedomykalności a rokowanie

Modele predykcyjne w chorobie zastawki trójdzielnej

TRI-SCORE jako narzędzie oceny ryzyka
Zastosowanie uczenia maszynowego w przewidywaniu rokowania

Nowe podejścia do klasyfikacji niedomykalności zastawki trójdzielnej
Podsumowanie – implikacje kliniczne

Kolejne rozdziały

Wprowadzenie do choroby zastawki trójdzielnej

Choroba zastawki trójdzielnej, charakteryzująca się głównie niedomykalnością zastawki (TR, ang. tricuspid regurgitation), stanowi istotny problem kliniczny o znaczącym wpływie na rokowanie pacjentów. Niedomykalność zastawki trójdzielnej jest częstym schorzeniem zastawkowym, którego częstość występowania w populacji ogólnej wynosi co najmniej 0,55%, osiągając nawet 7,2% u osób starszych (≥65 lat).¹ Pacjenci z niedomykalnością zastawki trójdzielnej mają 2,5-krotnie wyższe ryzyko zgonu w porównaniu z osobami bez wad zastawkowych, co podkreśla istotny wpływ tego schorzenia na rokowanie.¹ W ostatnich latach nastąpił znaczący postęp w zrozumieniu patofizjologii, diagnostyki i wpływu prognostycznego niedomykalności zastawki trójdzielnej w różnych populacjach pacjentów.¹

Prognostyczne znaczenie niedomykalności zastawki trójdzielnej

Znacząca niedomykalność zastawki trójdzielnej negatywnie wpływa na rokowanie pacjentów, a ryzyko niekorzystnych zdarzeń wzrasta wraz ze zwiększaniem się stopnia niedomykalności.² Warto podkreślić, że zarówno etiologia, jak i stopień niedomykalności mają istotne znaczenie dla rokowania.

Wpływ stopnia niedomykalności na rokowanie

Dostępne dane pokazują, że ciężka niedomykalność zastawki trójdzielnej wiąże się ze zwiększonym ryzykiem śmiertelności w porównaniu z pacjentami bez niedomykalności.³ Jednak również umiarkowana niedomykalność powoduje 15% wzrost śmiertelności w porównaniu z brakiem lub minimalną niedomykalnością.⁴ Co więcej, pacjenci z umiarkowaną lub ciężką niedomykalnością, zarówno pierwotną, jak i wtórną, mają dwukrotnie wyższe ryzyko ogólnej śmiertelności w porównaniu z osobami bez niedomykalności lub z minimalną niedomykalnością.⁵ Nawet łagodna niedomykalność zastawki trójdzielnej wiąże się ze zwiększoną śmiertelnością.⁶

Badania wskazują, że rokowanie w przypadku umiarkowanej lub ciężkiej niedomykalności zastawki trójdzielnej jest niekorzystne, z 6-letnim przeżyciem wolnym od zdarzeń wynoszącym tylko 57% zarówno dla umiarkowanej, jak i ciężkiej niedomykalności.⁷

Niedomykalność zastawki trójdzielnej w kontekscie innych chorób serca

Prognostyczna rola niedomykalności zastawki trójdzielnej związanej z organiczną chorobą zastawkową lewej strony serca jest dobrze znana.⁸ U pacjentów z dysfunkcją skurczową lewej komory i wtórną niedomykalnością zastawki trójdzielnej coraz więcej dowodów wskazuje na istotny wpływ prognostyczny TR, co sugeruje konieczność zmiany paradygmatu w ocenie i podejściu terapeutycznym do tej grupy pacjentów.⁹

Umiarkowana/ciężka niedomykalność zastawki trójdzielnej niezależnie przewiduje zgon i ponowną hospitalizację z powodu niewydolności serca w ciągu roku.¹⁰ Znaczenie niedomykalności zastawki trójdzielnej u pacjentów poddawanych przezcewnikowej implantacji zastawki aortalnej (TAVI) również zostało ostatnio zbadane: ciężka i masywna niedomykalność zastawki trójdzielnej po TAVI wiąże się z 2-krotnie zwiększonym ryzykiem zgonu z wszystkich przyczyn w ciągu 1 roku.¹¹

Czynniki prognostyczne w chorobie zastawki trójdzielnej

Nadciśnienie płucne jako kluczowy czynnik prognostyczny

Nadciśnienie płucne (PH) stanowi istotny czynnik prognostyczny u pacjentów z niedomykalnością zastawki trójdzielnej. W badaniach wykazano, że wskaźniki śmiertelności wyniosły 93 (67%) u pacjentów z PH w porównaniu do 30 (42%) u pacjentów bez PH (p<0,001).¹² Nadciśnienie płucne było związane z niższym przeżyciem wolnym od zdarzeń w umiarkowanej niedomykalności zastawki trójdzielnej (log-rank, p<0,001), ale nie w ciężkiej niedomykalności (log-rank, p=0,133).¹³

W wieloczynnikowej analizie regresji Coxa, po uwzględnieniu wieku, palenia tytoniu, choroby wieńcowej, zmniejszonej funkcji prawej komory, niższej frakcji wyrzutowej lewej komory na początku badania, wielkości prawego przedsionka i wymiany zastawki mitralnej, nadciśnienie płucne pozostało istotnym predyktorem śmiertelności z wszystkich przyczyn (HR 2,22; 95% CI 1,41 do 3,47, p=0,001).¹⁴ To sugeruje, że nadciśnienie płucne, a nie stopień niedomykalności zastawki trójdzielnej, jest najsilniejszym predyktorem rokowania.¹⁵

Progresja niedomykalności zastawki trójdzielnej

Częstość występowania funkcjonalnej niedomykalności zastawki trójdzielnej jest wysoka i wiąże się z niekorzystnymi wynikami. Niedomykalność może postępować z czasem, głównie w związku z przebudową prawostronnych jam serca.¹⁶ Umiarkowana i ciężka funkcjonalna niedomykalność zastawki trójdzielnej była związana z niekorzystnym rokowaniem (HR 1,91 (95% CI 1,15 do 3,2) dla umiarkowanej i 2,30 (95% CI 1,28 do 4,13) dla ciężkiej niedomykalności, po uwzględnieniu innych zmiennych prognostycznych.¹⁷

Skumulowana częstość progresji niedomykalności zastawki trójdzielnej w ciągu 10 lat wyniosła 34,3% (95% CI 25,8% do 41,9%) przy zastosowaniu modelu Kaplana-Meiera i 24,8% (CI 19,5% do 30,5%) przy zastosowaniu modelu Fine-Gray.¹⁸ W modelu Coxa, wiek (HR 1,708, 95%CI 1,343 do 2,172), klasa czynnościowa NYHA III/IV (HR 2,572, 95%CI 1,540 do 4,298), powierzchnia prawego przedsionka (HR 1,521, 95%CI 1,101 do 2,102) i obecność dysfunkcji prawej komory (HR 2,024, 95%CI 1,068 do 3,836) były niezależnymi predyktorami progresji niedomykalności zastawki trójdzielnej.¹⁹

Etiologia niedomykalności a rokowanie

Wpływ prognostyczny podstawowej etiologii funkcjonalnej niedomykalności zastawki trójdzielnej został ostatnio zbadany. U pacjentów ze znaczącą niedomykalnością poddawanych różnym opcjom leczenia, dysfunkcja prawej komory, identyfikowana przez zmniejszenie skurczowego ruchu płaszczyzny pierścienia trójdzielnego (TAPSE) i zmianę frakcyjną pola (FAC), była związana z wyższą śmiertelnością, podczas gdy zwiększenie rozszerzenia prawego przedsionka i pierścienia trójdzielnego było związane ze zmniejszoną śmiertelnością.²⁰ Wyniki te dostarczają dalszego wsparcia dla hipotezy, że przedsionkowa funkcjonalna niedomykalność zastawki trójdzielnej może mieć bardziej korzystne rokowanie w porównaniu z komorową funkcjonalną niedomykalnością zastawki trójdzielnej.²¹

Modele predykcyjne w chorobie zastawki trójdzielnej

TRI-SCORE jako narzędzie oceny ryzyka

TRI-SCORE został niedawno opracowany w Europie jako model ryzyka do przewidywania śmiertelności wewnątrzszpitalnej po izolowanej operacji zastawki trójdzielnej.²² Model ten został zwalidowany w populacji azjatyckiej i pomaga przewidywać długoterminowe wyniki po izolowanej operacji zastawki trójdzielnej.²³

TRI-SCORE dobrze przewidywał śmiertelność wewnątrzszpitalną po izolowanej operacji zastawki trójdzielnej z polem pod krzywą wynoszącym 0,84 u pacjentów azjatyckich, co jest zgodne z wynikami europejskimi z polem pod krzywą wynoszącym 0,81.²⁴ Wraz z wydłużaniem się okresu obserwacji po operacji, TRI-SCORE wykazywał bardziej statystycznie istotne wyniki niż EuroScore II.²⁵

TRI-SCORE posiadał znaczącą moc predykcyjną długoterminowego rokowania (indeks zgodności 0,77), czego nie wykazał EuroScore II (indeks zgodności 0,58).²⁶ Badanie to potwierdziło przydatność TRI-SCORE do ogólnej predykcji wyników po izolowanej operacji zastawki trójdzielnej.²⁷

Zastosowanie uczenia maszynowego w przewidywaniu rokowania

Uczenie maszynowe na podstawie powszechnych cech klinicznych i echokardiograficznych może ocenić ryzyko śmiertelności u pacjentów z niedomykalnością zastawki trójdzielnej.²⁸ Ogólna wydajność dla 1-rocznej śmiertelności według 3 modeli uczenia maszynowego była dobra, z c-statystyką 0,74-0,75.²⁹

Co ciekawe, wydajność różniła się między grupami CCI (Charlson Comorbidity Index), (c-statystyka = 0,774 w najniższej grupie CCI i 0,661 w najwyższej grupie CCI).³⁰ Wydajność zmniejszała się w ciągu 3-letniej obserwacji (średni indeks c 0,78).³¹

Badanie obejmujące 13312 pacjentów z umiarkowaną niedomykalnością zastawki trójdzielnej wykazało, że:

Algorytm oparty na uczeniu maszynowym miał dobrą wydajność w szacowaniu śmiertelności u pacjentów z umiarkowaną niedomykalnością zastawki trójdzielnej³²
Główne zmienne uwzględnione w modelu uczenia maszynowego związane ze śmiertelnością to wiek, wskaźnik masy ciała, parametry życiowe (częstość akcji serca i ciśnienie krwi), choroby współistniejące, takie jak przewlekła choroba nerek i wcześniejsza operacja serca, oznaki zastoju, użycie diuretyków, AST, kreatynina i hiponatremia, oraz cechy echokardiograficzne: ciśnienie skurczowe prawej komory, frakcja wyrzutowa lewej komory, wymiar końcowo-rozkurczowy lewej komory³³
Dokładność tych modeli była umiarkowanie wysoka, z C-statystyką 0,75 dla najlepszego modelu³⁴

Predykcja była najsilniejsza w grupie z niskim indeksem chorób współistniejących, co sugeruje, że sama niedomykalność zastawki trójdzielnej może być ważniejszym czynnikiem prognostycznym u osób z mniejszą liczbą chorób współistniejących.³⁵ Prosty model oparty na uczeniu maszynowym, wykorzystujący powszechne cechy kliniczne i echokardiograficzne, może przewidywać śmiertelność u pacjentów z umiarkowaną niedomykalnością zastawki trójdzielnej z rozsądną precyzją.³⁶

Nowe podejścia do klasyfikacji niedomykalności zastawki trójdzielnej

Współczesny rozszerzony schemat został ponownie oceniony przez konsensus TVARC. Dreyfus i wsp. niedawno zaproponowali nową klasyfikację stopnia niedomykalności zastawki trójdzielnej, różnicującą grupę umiarkowanego stopnia na podgrupy łagodną do umiarkowanej i umiarkowaną do ciężkiej, ze względu na znacząco różne rokowanie, co skutkuje czterostopniową klasyfikacją (łagodna, łagodna do umiarkowanej, umiarkowana do ciężkiej i ciężka) podobną do klasyfikacji niedomykalności mitralnej lub sześciostopniową klasyfikacją, jeśli uwzględnić klasyfikację masywną i torrencjalną.³⁷

Podsumowanie – implikacje kliniczne

Choroba zastawki trójdzielnej, szczególnie niedomykalność, nie jest jedynie biernym obserwatorem w różnych procesach chorobowych, w które jest zaangażowana, ale raczej aktywnym uczestnikiem patofizjologii i ewolucji choroby, negatywnie wpływającym na wyniki.³⁸ Dokładna ocena obrazowa dostarcza wskazówek prognostycznych, które mogą pomóc w identyfikacji pacjentów, którzy najbardziej skorzystają z interwencji.

Najnowsze wytyczne ESC/EACTS dotyczące chorób zastawkowych serca zalecają, aby leczenie interwencyjne wtórnej niedomykalności zastawki trójdzielnej było rozważane w doświadczonych ośrodkach u anatomicznie kwalifikujących się pacjentów objawowych, którzy nie są uznawani za dobrych kandydatów do operacji.³⁹ Postępy w technikach chirurgicznych i stratyfikacji ryzyka doprowadziły do ponownej oceny operacji zastawki trójdzielnej, kiedyś uważanej za wysokiego ryzyka.

TRI-SCORE, który uwzględnia osiem parametrów klinicznych i obrazowych, może przewidywać śmiertelność wewnątrzszpitalną po izolowanej operacji trójdzielnej, pomagając w procesie podejmowania decyzji klinicznych.⁴⁰ Niemniej jednak znaczna część pacjentów z niedomykalnością zastawki trójdzielnej to osoby starsze i obciążone chorobami współistniejącymi, a zatem niezdolne do (ponownej) operacji, podczas gdy przezcewnikowa interwencja zastawki trójdzielnej (TTVI) jest bezpieczną opcją u pacjentów z wysoką kategorią TRI-SCORE.⁴¹

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Materiały źródłowe

#1 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
Tricuspid regurgitation (TR) is a prevalent valvular heart disease that significantly impacts prognosis and quality of life. Moderate TR has a prevalence of at least 0.55% in the general population, reaching a prevalence as high as 7.2% in the older population (â¥65 years) in a recent community-based study. Compared to patients with no valvular heart disease, those with TR had a 2.5 higher risk of death in a large UK Biobank cohort. Another large study confirmed the association of increasing TR severity with adverse outcomes, suggesting that even mild TR has a significant prognostic impact. In recent years, the importance of prompt recognition and treatment of TR has been acknowledged and intense research work has worked to clarify important aspects of TR diagnosis, its pathophysiology, and its prognostic impact in diverse TR populations. The latest 2021 ESC/EACTS valvular heart disease guidelines recommend that interventional treatment of secondary TR is considered in experienced centers in anatomically eligible symptomatic patients who are not deemed good surgical candidates. Meanwhile, advances in surgical techniques and risk stratification have led to a reappraisal of tricuspid valve (TV) surgery, once considered high-risk. The TRI-SCORE incorporates eight clinical and imaging parameters and can predict in-hospital mortality following isolated tricuspid surgery, assisting in the clinical decision-making process. Nonetheless, a significant proportion of patients with TR are elder and comorbid and thus unfit for (re-do) surgery, whereas tricuspid transcatheter valve intervention (TTVI) is a safe option in high-TRI-SCORE-category patients. Recently, a dedicated risk score (TRIVALVE score) has been developed specifically for this population.
#2 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Tricuspid regurgitation (TR) has a considerable prevalence in the overall population, that further increases in selected categories of patients. […] Recent evidences demonstrate a negative impact of TR on outcomes, irrespective of etiology and even when less than severe in grading. […] Growing evidence has shown deleterious outcomes of untreated TR irrespective of left or right ventricular function and pulmonary hypertension in the surgical, percutaneous, and heart failure populations studied. […] This review will address the available evidence concerning the prognostic impact of TR in the different contexts with a particular focus on secondary TR. […] Significant TR impacts negatively patient prognosis, and it does so more and more for every increase in grade of severity. […] The severity of disease does play a central role: Severe TR is associated with increased risk of mortality when compared with patients with no TR in retrospective registries.
#3 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Tricuspid regurgitation (TR) has a considerable prevalence in the overall population, that further increases in selected categories of patients. […] Recent evidences demonstrate a negative impact of TR on outcomes, irrespective of etiology and even when less than severe in grading. […] Growing evidence has shown deleterious outcomes of untreated TR irrespective of left or right ventricular function and pulmonary hypertension in the surgical, percutaneous, and heart failure populations studied. […] This review will address the available evidence concerning the prognostic impact of TR in the different contexts with a particular focus on secondary TR. […] Significant TR impacts negatively patient prognosis, and it does so more and more for every increase in grade of severity. […] The severity of disease does play a central role: Severe TR is associated with increased risk of mortality when compared with patients with no TR in retrospective registries.
#4 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#5 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#6 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#7 Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/6/2/e001104
Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. […] The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p0.001). […] PH was associated with lower event-free survival in moderate (log-rank, p0.001), but not in severe TR (log-rank, p=0.133). […] In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95%CI 1.41 to 3.47, p=0.001). […] The presence of significant TR was associated with a 6-year event-free survival, only 57% for both moderate and severe TR. However, PH rather than the grade of TR was the most powerful predictor of outcome. […] The prognosis of moderate or severe TR is poor with a high mortality rate observed in patients with moderate TR and PH.
#8 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#9 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#10 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#11 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#12 Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/6/2/e001104
Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. […] The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p0.001). […] PH was associated with lower event-free survival in moderate (log-rank, p0.001), but not in severe TR (log-rank, p=0.133). […] In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95%CI 1.41 to 3.47, p=0.001). […] The presence of significant TR was associated with a 6-year event-free survival, only 57% for both moderate and severe TR. However, PH rather than the grade of TR was the most powerful predictor of outcome. […] The prognosis of moderate or severe TR is poor with a high mortality rate observed in patients with moderate TR and PH.
#13 Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/6/2/e001104
Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. […] The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p0.001). […] PH was associated with lower event-free survival in moderate (log-rank, p0.001), but not in severe TR (log-rank, p=0.133). […] In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95%CI 1.41 to 3.47, p=0.001). […] The presence of significant TR was associated with a 6-year event-free survival, only 57% for both moderate and severe TR. However, PH rather than the grade of TR was the most powerful predictor of outcome. […] The prognosis of moderate or severe TR is poor with a high mortality rate observed in patients with moderate TR and PH.
#14 Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/6/2/e001104
Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. […] The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p0.001). […] PH was associated with lower event-free survival in moderate (log-rank, p0.001), but not in severe TR (log-rank, p=0.133). […] In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95%CI 1.41 to 3.47, p=0.001). […] The presence of significant TR was associated with a 6-year event-free survival, only 57% for both moderate and severe TR. However, PH rather than the grade of TR was the most powerful predictor of outcome. […] The prognosis of moderate or severe TR is poor with a high mortality rate observed in patients with moderate TR and PH.
#15 Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/6/2/e001104
Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. […] The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p0.001). […] PH was associated with lower event-free survival in moderate (log-rank, p0.001), but not in severe TR (log-rank, p=0.133). […] In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95%CI 1.41 to 3.47, p=0.001). […] The presence of significant TR was associated with a 6-year event-free survival, only 57% for both moderate and severe TR. However, PH rather than the grade of TR was the most powerful predictor of outcome. […] The prognosis of moderate or severe TR is poor with a high mortality rate observed in patients with moderate TR and PH.
#16 Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC10476137/
Functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling. […] Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. […] In patients with RHD, functional TR was frequent and associated with adverse outcomes, independent of symptoms and other well-established prognostic parameters. TR may progress over time, predicted by age, NYHA functional class and right-sided cardiac chambers remodelling. […] The cumulative incidence of TR progression over 10 years was 34.3% (95% CI 25.8% to 41.9%) when using the Kaplan-Meier model and was 24.8% (CI 19.5% to 30.5%) when using the Fine-Gray model. Predictors of TR progression were assessed in two multivariable models and the results were compared controlling for AF, pulmonary artery pressure and RV dysfunction. […] In the Cox model, age (HR 1.708, 95%CI 1.343 to 2.172), NYHA functional class III/IV (HR 2.572, 95%CI 1.540 to 4.298), RA area (HR 1.521, 95%CI 1.101 to 2.102) and presence of RV dysfunction (HR 2.024, 95%CI 1.068 to 3.836) were independently predictive of TR progression.
#17 Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC10476137/
Functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling. […] Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. […] In patients with RHD, functional TR was frequent and associated with adverse outcomes, independent of symptoms and other well-established prognostic parameters. TR may progress over time, predicted by age, NYHA functional class and right-sided cardiac chambers remodelling. […] The cumulative incidence of TR progression over 10 years was 34.3% (95% CI 25.8% to 41.9%) when using the Kaplan-Meier model and was 24.8% (CI 19.5% to 30.5%) when using the Fine-Gray model. Predictors of TR progression were assessed in two multivariable models and the results were compared controlling for AF, pulmonary artery pressure and RV dysfunction. […] In the Cox model, age (HR 1.708, 95%CI 1.343 to 2.172), NYHA functional class III/IV (HR 2.572, 95%CI 1.540 to 4.298), RA area (HR 1.521, 95%CI 1.101 to 2.102) and presence of RV dysfunction (HR 2.024, 95%CI 1.068 to 3.836) were independently predictive of TR progression.
#18 Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC10476137/
Functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling. […] Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. […] In patients with RHD, functional TR was frequent and associated with adverse outcomes, independent of symptoms and other well-established prognostic parameters. TR may progress over time, predicted by age, NYHA functional class and right-sided cardiac chambers remodelling. […] The cumulative incidence of TR progression over 10 years was 34.3% (95% CI 25.8% to 41.9%) when using the Kaplan-Meier model and was 24.8% (CI 19.5% to 30.5%) when using the Fine-Gray model. Predictors of TR progression were assessed in two multivariable models and the results were compared controlling for AF, pulmonary artery pressure and RV dysfunction. […] In the Cox model, age (HR 1.708, 95%CI 1.343 to 2.172), NYHA functional class III/IV (HR 2.572, 95%CI 1.540 to 4.298), RA area (HR 1.521, 95%CI 1.101 to 2.102) and presence of RV dysfunction (HR 2.024, 95%CI 1.068 to 3.836) were independently predictive of TR progression.
#19 Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC10476137/
Functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling. […] Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. […] In patients with RHD, functional TR was frequent and associated with adverse outcomes, independent of symptoms and other well-established prognostic parameters. TR may progress over time, predicted by age, NYHA functional class and right-sided cardiac chambers remodelling. […] The cumulative incidence of TR progression over 10 years was 34.3% (95% CI 25.8% to 41.9%) when using the Kaplan-Meier model and was 24.8% (CI 19.5% to 30.5%) when using the Fine-Gray model. Predictors of TR progression were assessed in two multivariable models and the results were compared controlling for AF, pulmonary artery pressure and RV dysfunction. […] In the Cox model, age (HR 1.708, 95%CI 1.343 to 2.172), NYHA functional class III/IV (HR 2.572, 95%CI 1.540 to 4.298), RA area (HR 1.521, 95%CI 1.101 to 2.102) and presence of RV dysfunction (HR 2.024, 95%CI 1.068 to 3.836) were independently predictive of TR progression.
#20 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
The contemporary expanded scheme has been reappraised by the TVARC consensus. Dreyfus et al. have recently advocated for a new TR severity classification differentiating the moderate-degree group into mild-to-moderate and moderate-to-severe subgroups, due to a significantly different prognosis, resulting in a four-degree classification (mild, mild-to-moderate, moderate-to-severe, and severe) similar to the mitral regurgitation grading or a six-degree classification if incorporating the massive and torrential grading. […] The prognostic impact of the underlying etiology of functional TR has been recently shown that in patients with significant TR undergoing different treatment options, RV dysfunction, identified by reduction of tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC), was associated with higher mortality, whereas increasing RA and tricuspid annulus dilation were associated with reduced mortality. These findings provide further support for the hypothesis that atrial functional TR may have a more favorable prognostic outcome compared with ventricular functional TR. Therefore, a thorough imaging assessment provides prognostic clues which may help to identify those patients who will most benefit from TTVI.
#21 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
The contemporary expanded scheme has been reappraised by the TVARC consensus. Dreyfus et al. have recently advocated for a new TR severity classification differentiating the moderate-degree group into mild-to-moderate and moderate-to-severe subgroups, due to a significantly different prognosis, resulting in a four-degree classification (mild, mild-to-moderate, moderate-to-severe, and severe) similar to the mitral regurgitation grading or a six-degree classification if incorporating the massive and torrential grading. […] The prognostic impact of the underlying etiology of functional TR has been recently shown that in patients with significant TR undergoing different treatment options, RV dysfunction, identified by reduction of tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC), was associated with higher mortality, whereas increasing RA and tricuspid annulus dilation were associated with reduced mortality. These findings provide further support for the hypothesis that atrial functional TR may have a more favorable prognostic outcome compared with ventricular functional TR. Therefore, a thorough imaging assessment provides prognostic clues which may help to identify those patients who will most benefit from TTVI.
#22 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#23 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#24 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#25 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#26 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#27 Validation of TRIâSCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC11262506/
TRISCORE was recently developed in Europe as a risk model for predicting inhospital death after isolated tricuspid valve surgery. We aimed to validate TRISCORE in an Asian population and investigate its value for predicting longterm outcomes. […] TRISCORE was validated in an Asian population and helped predict longterm outcomes after isolated tricuspid valve surgery. […] TRISCORE well predicted inhospital death after isolated tricuspid valve surgery with an area under the curve of 0.84 in Asian patients, consistent with the European results with an area under the curve of 0.81. […] As the followup period after surgery increased, TRISCORE demonstrated more statistically significant results than EuroScore II. […] TRISCORE possessed significant predictive power of longterm prognosis (concordance index, 0.77), which was not revealed by EuroScore II (concordance index, 0.58). […] The present study verified the usefulness of TRISCORE for overall outcome prediction after ITVS.
#28 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#29 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#30 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#31 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#32 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#33 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#34 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. […] Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. […] The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.740.75. […] Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). […] The performance decreased over 3-year follow-up (average c-index 0.78). […] Our study including 13312 patients with moderate TR has several important novel findings: (1) an ML-based algorithm had good performance in estimating mortality in patients with moderate TR; (2) the top variables included in the ML model associated with mortality were age, body mass index, vitals (heart rate and blood pressure), comorbidities such as CKD and prior cardiac surgery, signs of congestiondiuretic use, AST, creatinine and hyponatraemia, and echocardiographic features RV systolic pressure, LV ejection fraction, LV end-diastolic dimension; (3) the accuracy of these model was moderately high, with a C-statistic of 0.75 on the best model.
#35 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
The prediction was strongest in the low comorbidity index group again suggesting that TR itself may be more important in predicting survival in those with fewer comorbidities. […] In conclusion, our simple machine-learning based model using common clinical and echocardiographic features can predict mortality in patients with moderate TR with a reasonable precision.
#36 Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation | Open Heart
https://openheart.bmj.com/content/10/2/e002417
The prediction was strongest in the low comorbidity index group again suggesting that TR itself may be more important in predicting survival in those with fewer comorbidities. […] In conclusion, our simple machine-learning based model using common clinical and echocardiographic features can predict mortality in patients with moderate TR with a reasonable precision.
#37 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
The contemporary expanded scheme has been reappraised by the TVARC consensus. Dreyfus et al. have recently advocated for a new TR severity classification differentiating the moderate-degree group into mild-to-moderate and moderate-to-severe subgroups, due to a significantly different prognosis, resulting in a four-degree classification (mild, mild-to-moderate, moderate-to-severe, and severe) similar to the mitral regurgitation grading or a six-degree classification if incorporating the massive and torrential grading. […] The prognostic impact of the underlying etiology of functional TR has been recently shown that in patients with significant TR undergoing different treatment options, RV dysfunction, identified by reduction of tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC), was associated with higher mortality, whereas increasing RA and tricuspid annulus dilation were associated with reduced mortality. These findings provide further support for the hypothesis that atrial functional TR may have a more favorable prognostic outcome compared with ventricular functional TR. Therefore, a thorough imaging assessment provides prognostic clues which may help to identify those patients who will most benefit from TTVI.
#38 Prognostic value of tricuspid regurgitation
https://www.imrpress.com/journal/RCM/23/2/10.31083/j.rcm2302076/htm
Moderate TR also yields a 15% increase in mortality when compared with no or minimal TR. […] Patients with moderate or severe primary or secondary TR had double the risk of overall mortality when compared with no or minimal TR. […] Mild TR has been linked to increased mortality as well. […] The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. […] Moderate/severe TR independently predicted death and re-hospitalization for heart failure at 1 year. […] The impact of TR in patients undergoing TAVI has also been recently addressed: severe and massive TR post-TAVI is associated with a 2-fold increased risk of 1-year all-cause death. […] Overall, the evidence supports an important prognostic role for TR in patients with LV systolic dysfunction and calls for a paradigm shift in evaluation and therapeutic approach of patients with LV systolic dysfunction and secondary TR. […] There is a growing body of evidence today that significant TR is not merely a bystander in the different disease processes in which it is involved, but rather is an active player in the pathophysiology and evolution of disease, impacting negatively on outcomes.
#39 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
Tricuspid regurgitation (TR) is a prevalent valvular heart disease that significantly impacts prognosis and quality of life. Moderate TR has a prevalence of at least 0.55% in the general population, reaching a prevalence as high as 7.2% in the older population (â¥65 years) in a recent community-based study. Compared to patients with no valvular heart disease, those with TR had a 2.5 higher risk of death in a large UK Biobank cohort. Another large study confirmed the association of increasing TR severity with adverse outcomes, suggesting that even mild TR has a significant prognostic impact. In recent years, the importance of prompt recognition and treatment of TR has been acknowledged and intense research work has worked to clarify important aspects of TR diagnosis, its pathophysiology, and its prognostic impact in diverse TR populations. The latest 2021 ESC/EACTS valvular heart disease guidelines recommend that interventional treatment of secondary TR is considered in experienced centers in anatomically eligible symptomatic patients who are not deemed good surgical candidates. Meanwhile, advances in surgical techniques and risk stratification have led to a reappraisal of tricuspid valve (TV) surgery, once considered high-risk. The TRI-SCORE incorporates eight clinical and imaging parameters and can predict in-hospital mortality following isolated tricuspid surgery, assisting in the clinical decision-making process. Nonetheless, a significant proportion of patients with TR are elder and comorbid and thus unfit for (re-do) surgery, whereas tricuspid transcatheter valve intervention (TTVI) is a safe option in high-TRI-SCORE-category patients. Recently, a dedicated risk score (TRIVALVE score) has been developed specifically for this population.
#40 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
Tricuspid regurgitation (TR) is a prevalent valvular heart disease that significantly impacts prognosis and quality of life. Moderate TR has a prevalence of at least 0.55% in the general population, reaching a prevalence as high as 7.2% in the older population (â¥65 years) in a recent community-based study. Compared to patients with no valvular heart disease, those with TR had a 2.5 higher risk of death in a large UK Biobank cohort. Another large study confirmed the association of increasing TR severity with adverse outcomes, suggesting that even mild TR has a significant prognostic impact. In recent years, the importance of prompt recognition and treatment of TR has been acknowledged and intense research work has worked to clarify important aspects of TR diagnosis, its pathophysiology, and its prognostic impact in diverse TR populations. The latest 2021 ESC/EACTS valvular heart disease guidelines recommend that interventional treatment of secondary TR is considered in experienced centers in anatomically eligible symptomatic patients who are not deemed good surgical candidates. Meanwhile, advances in surgical techniques and risk stratification have led to a reappraisal of tricuspid valve (TV) surgery, once considered high-risk. The TRI-SCORE incorporates eight clinical and imaging parameters and can predict in-hospital mortality following isolated tricuspid surgery, assisting in the clinical decision-making process. Nonetheless, a significant proportion of patients with TR are elder and comorbid and thus unfit for (re-do) surgery, whereas tricuspid transcatheter valve intervention (TTVI) is a safe option in high-TRI-SCORE-category patients. Recently, a dedicated risk score (TRIVALVE score) has been developed specifically for this population.
#41 Key Imaging Factors for Transcatheter Management of Tricuspid Regurgitation: Device and Patient Selection
https://www.mdpi.com/2077-0383/13/20/6144
Tricuspid regurgitation (TR) is a prevalent valvular heart disease that significantly impacts prognosis and quality of life. Moderate TR has a prevalence of at least 0.55% in the general population, reaching a prevalence as high as 7.2% in the older population (â¥65 years) in a recent community-based study. Compared to patients with no valvular heart disease, those with TR had a 2.5 higher risk of death in a large UK Biobank cohort. Another large study confirmed the association of increasing TR severity with adverse outcomes, suggesting that even mild TR has a significant prognostic impact. In recent years, the importance of prompt recognition and treatment of TR has been acknowledged and intense research work has worked to clarify important aspects of TR diagnosis, its pathophysiology, and its prognostic impact in diverse TR populations. The latest 2021 ESC/EACTS valvular heart disease guidelines recommend that interventional treatment of secondary TR is considered in experienced centers in anatomically eligible symptomatic patients who are not deemed good surgical candidates. Meanwhile, advances in surgical techniques and risk stratification have led to a reappraisal of tricuspid valve (TV) surgery, once considered high-risk. The TRI-SCORE incorporates eight clinical and imaging parameters and can predict in-hospital mortality following isolated tricuspid surgery, assisting in the clinical decision-making process. Nonetheless, a significant proportion of patients with TR are elder and comorbid and thus unfit for (re-do) surgery, whereas tricuspid transcatheter valve intervention (TTVI) is a safe option in high-TRI-SCORE-category patients. Recently, a dedicated risk score (TRIVALVE score) has been developed specifically for this population.