Materiały źródłowe

• #1 Tricuspid valve regurgitation: no longer the “forgotten valve”

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Tricuspid-valve-regurgitation-no-longer-the-forgotten-valve

  Tricuspid regurgitation (TR) is often an incidental finding on routine echocardiography. While a mild degree is generally regarded as a benign physiological entity, moderate and severe TR are associated with worse outcome. The Framingham Heart Study, a large cardiovascular cohort study, showed that the presence of any severity of TR (ranging from trace to more than moderate) was 82% in men and 85.7% in women. The progression from a mild to significant degree of TR is influenced by age and gender. With increasing age, the prevalence of significant TR increases, and in men and women aged 70 years the prevalence of moderate and severe TR reaches up to 1.5% and 5.6%, respectively. Other echocardiographic database studies have reported even higher frequencies of significant TR (up to 16%), which may indicate the varying methodology in grading TR severity in the current literature. In the USA, the prevalence of moderate and severe TR is estimated to be around 1,600,000, far exceeding the estimated number of patients being surgically treated today (8,000/year).

• #1 Tricuspid regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Tricuspid_regurgitation_epidemiology_and_demographics

  The prevalence of TR (with a severity ranging from trace to moderate regurgitation) was 82% in men and 85.7% in women. […] When trace regurgitation is excluded, the prevalence of TR of a severity mild was 14.8% in men and 18.4% in women. […] The severity of tricuspid regurgitation increases with age. […] As the age increases the severity of TR also increases especially in people who are more than 70 years of age. […] There is no racial predilection to tricuspid regurgitation. […] Women are little more commonly affected by tricuspid regurgitation than males. […] The progression of tricuspid regurgitation from mild to moderate to severe also based upon the gender.

• #1 Tricuspid regurgitation – Part 1: evaluation and risk stratification

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-1-evaluation-and-risk-stratification

  Tricuspid regurgitation (TR) is a common finding in the general population with increasing prevalence in elderly patients, leading to impaired functional capacity, peripheral oedema, ascites, and congestive right heart failure with renal and hepatic impairment. […] Relevant (moderate) TR is estimated to affect 4% of the population over 75 years of age, which is comparable to the prevalence of aortic stenosis and mitral regurgitation. […] In recent years, evidence has accumulated that significant TR is associated with an increased mortality of 40-70% after 1-4 years, even when adjusted for comorbidities. […] Despite increasing evidence, TR remains a rarely assessed and treated valve disease and patients are often referred too late, when irreversible right heart failure is present and subsequent treatment is associated with increased operative risk.

• #1 Tricuspid regurgitation – Wikipedia

  https://en.wikipedia.org/wiki/Tricuspid_regurgitation

  In The Framingham Heart Study, presence of tricuspid regurgitation of mild severity or greater, was present in about 14.8% of men and 18.4% of women. […] Mild tricuspid regurgitation tends to be common and, in the presence of a structurally normal tricuspid valve apparatus, can be considered a normal variant. […] Clinically significant TR is more common in females, this is thought to be partly driven by the increased prevalence of atrial fibrillation and heart failure with preserved ejection fraction (both risk factors for TR) in women as compared to men. […] Moderate or severe tricuspid regurgitation is usually associated with tricuspid valve leaflet abnormalities and/or possibly annular dilation and is usually pathologic which can lead to irreversible damage of cardiac muscle and worse outcomes due to chronic prolonged right ventricular volume overload. […] In a study of 595 male elite football players aged 18-38, and 47 sedentary non-athletes, it was found that 58% of the athletes had tricuspid regurgitation vs. 36% in non-athletes.

• #1 Tricuspid Regurgitation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526121/

  Moderate to severe tricuspid regurgitation (TR) affects approximately 3% to 6% of the general population. […] Still, its prevalence is significantly higher among patients with left-sided valve disorders, particularly those with heart failure (HF), encompassing both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), where it ranges from 10% to 23%. […] In the context of heart failure, TR is linked to a higher risk of mortality and increased rates of HF-related hospitalizations. […] The negative impact on prognosis escalates with the severity of TR and persists regardless of right ventricular dysfunction, pulmonary hypertension, associated mitral regurgitation, left ventricular dysfunction, or atrial fibrillation. […] Tricuspid regurgitation presents at different age groups depending on its etiology.

• #1 Frontiers | Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.713658/full

  Atrioventricular regurgitation is frequent in the setting of heart failure. […] Similarly, tricuspid regurgitation (TR) is recognised as a common valve disease, observed in more than 1.6 million individuals in the United States. More than 80% of TR encountered in clinical practise is secondary, related to either left-sided valvular diseases, chronic atrial fibrillation, or global heart failure. […] In the ESC-HF-LT Registry moderate to severe TR was equally prevalent among HF subtypes, affecting approximately 20 % of the patients with HF. […] In a large cohort of patients with HFrEF, increasing TR severity was independently associated with considerably worse prognosis. Five-year survival was only 45 ± 2% for moderate TR, and 34 ± 4% for severe TR. […] Interestingly, the independent impact of TR on mortality was sustained whatever the ejection fraction was.

• #1 Echocardiographic Evaluation of the Tricuspid Valve: A Quick and Updated Guide

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/10/25/13/49/Echocardiographic-Evaluation-of-the-Tricuspid-Valve

  Tricuspid regurgitation (TR) is a common condition and its prevalence is only expected to increase with the aging population, rising rates of atrial fibrillation, and increased use of intracardiac devices (e.g., pacemakers). […] A contemporary cohort showed 4.5% of the community and 12% of hospitalized patients had significant TR (equal to moderate or greater severity), which increased to 23% among patients with heart failure with reduced ejection fraction (HFrEF). […] Over 90% of TR is due to functional etiologies, including left-sided valvular disease, pulmonary hypertension, left ventricular (LV) dysfunction, or dilation of the tricuspid apparatus resulting in an incompetent valve. […] TR is associated with heart failure hospitalizations (RR 1.73) and all-cause mortality (RR 1.61 and 3.44 for moderate and severe TR, respectively).

• #1 Tricuspid regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Tricuspid_regurgitation_epidemiology_and_demographics

  Tricuspid regurgitation (TR) of mild degree is common in individuals with anatomically normal valves and it has no physiological consequence. Approximately 1.6 million individuals in the USA are estimated to have moderate or severe tricuspid regurgitation. Secondary TR is more common than primary TR, accounting for more than 80% of the TR seen in clinical practice. […] The incidence of tricuspid regurgitation is approximately 0.9% in USA. […] The incidence of tricuspid regurgitation is approximately 1% internationally. […] Secondary tricuspid regurgitation constitutes about 80% of significant TR. […] The prevalence of tricuspid regurgitation is approximately 1,600,000 in USA. […] Moderate or severe tricuspid regurgitation has been estimated to be present in up to 16 million individuals in the USA.

• #1 Epidemiology, Pathophysiology, and Natural History of Tricuspid Valve Regurgitation and Stenosis | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-92046-3_2

  Tricuspid regurgitation is a common finding among normal individuals but is usually low grade and of doubtful clinical significance. […] Clinically significant tricuspid regurgitation is most often secondary to right ventricle pressure and/or volume overload, which may come from mitral valve disease, left ventricular dysfunction, pulmonary hypertension, or dilated cardiomyopathies. […] The presence of severe tricuspid regurgitation increases mortality in many settings and can cause significant morbidity in the form of edema and abdominal viscera congestion. […] Tricuspid stenosis is a rare entity that is most commonly caused by rheumatic heart disease but is also found in carcinoid disease.

• #1 Tricuspid regurgitation: what is the real clinical impact and how often should it be treated? | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-regurgitation-what-is-the-real-clinical-impact-and-how-often-should-it-be-treated

  Tricuspid regurgitation (TR) is a frequently occurring valvular disease in the elderly population, the aetiology is functional in the vast majority of cases, and this valvular disease has become increasingly recognised as an independent predictor of morbidity and mortality. […] The Framingham Heart Study showed that the prevalence of clinically significant (i.e., moderate or severe) TR in the general population reached up to 5.6% of women and 1.5% of men older than 70 years. […] Thus, the already notable prevalence of significant TR will most likely increase dramatically in the near future. […] Recent epidemiological data indicate that FTR accounts for 90% of all-comers with severe TR, and in total 65% of FTR occurs in the context of pulmonary hypertension. […] The most cited article demonstrating the negative prognostic impact of FTR showed that, in a retrospective evaluation of 5,223 patients, mortality increased with increasing severity of TR.

• #1 Tricuspid Regurgitation: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/158484-overview

  The incidence of tricuspid regurgitation in the United States appears to be 0.9%. Internationally, the incidence of tricuspid regurgitation also appears to be less than 1%. No racial or sexual differences in incidence are apparent. […] Age at presentation varies with the etiology of tricuspid regurgitation. Ebstein anomaly can be detected at birth and during early childhood. In patients older than 15 years, the most common form of tricuspid regurgitation is rheumatic valvular disease. In the adult population, other predisposing factors take precedence; these include carcinoid, bacterial endocarditis, and heart failure.

• #1 Etiology, epidemiology, pathophysiology and management of tricuspid regurgitation: an overview

  https://www.imrpress.com/journal/rcm/22/4/10.31083/j.rcm2204122

  Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men. […] This review summarizes data concerning etiology, epidemiology, pathophysiology and management strategies of TR. […] Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target.

• #1 Tricuspid Regurgitation | Thoracic Key

  https://thoracickey.com/tricuspid-regurgitation/

  With respect to heart valve diseases, until recently tricuspid valve regurgitation has received less attention than aortic or mitral valve lesions and therefore has been referred to as the forgotten valve. […] Using echocardiography, the Framingham Heart Study investigators found a prevalence of moderate or severe tricuspid regurgitation of 0.8% and an increased prevalence with aging. Overall, the prevalence of significant tricuspid regurgitation was 4.3 times greater in females than in males. […] Finally, the development of hemodynamically significant tricuspid regurgitation has been reported in 27% of patients who had only mild tricuspid regurgitation at the time of left-sided valve surgery. […] It has been reported that increasing severity of tricuspid regurgitation is associated with worsening prognosis, independently from left ventricular function or pulmonary pressure.

• #1 Natural course of tricuspid regurgitation and prognostic implications | Open Heart

  https://openheart.bmj.com/content/8/1/e001529

  Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR. […] TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) and left ventricular ejection fraction (LV-EF). […] While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival. […] This is the first study to assess TR and its natural course according to quantitative echocardiographic measures, including measurement of TR and the right ventricle in particular. We identified TR grade, RV dysfunction, pulmonary pressure and TR progression as independent predictors for survival besides known risk factors such as left ventricular ejection fraction, NT-proBNP, aortic stenosis, type 2 diabetes and atrial fibrillation. […] Moderate and severe TR had prognostic value irrespective of sPAP and LV-EF. However, survival was lowest in patients with concomitant elevated sPAP and reduced LV-EF. […] Patients with TR progression showed significantly worse survival.

• #1 Tricuspid regurgitation: what is the real clinical impact and how often should it be treated? | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-regurgitation-what-is-the-real-clinical-impact-and-how-often-should-it-be-treated

  Moderate or greater TR was associated with increased mortality regardless of pulmonary artery pressure, and left ventricular ejection fraction (LVEF). […] More recently, moderate-to-severe isolated FTR was shown to be independently associated with excess mortality in FTR patients with preserved LVEF and pulmonary hypertension. […] Natural history studies focusing on isolated FTR are of clinical interest to distinguish between the prognostic role of TR per se vs. comorbidities associated with TR which may impair outcomes. […] The development of significant TR after left-sided valve surgery is not uncommon and is associated with an unfavourable outcome. […] The high mortality rates associated with TV surgery highlight the biggest challenge in treating this group of patients, i.e., the negative impact of late presentation on outcomes.

• #1 Pulsenotes | Tricuspid regurgitation

  https://app.pulsenotes.com/medicine/cardiology/notes/tricuspid-regurgitation

  Mild tricuspid regurgitation affects ~80% of healthy adults. […] Mild TR is extremely common, affecting approximately 80% of healthy adults. It is so common that it can be considered normal. However, moderate-to-severe TR is less common, affecting 1 in 200 adult patients. […] TR tends to affect older patients: 1 in 25 patients over the age of 75 has moderate or severe TR.

• #1 Tricuspid Regurgitation Diagnosis, Imaging, and Management: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/02/14/18/tricuspid-regurgitation-from

  Tricuspid regurgitation (TR) is prevalent and associated with high mortality but underdiagnosed and profoundly undertreated by surgery. […] Surveillance with transthoracic echocardiography (TTE) after a surgical or transcatheter intervention typically is performed before discharge; 1 month, 6 months, and 1 year after intervention, and then yearly. […] Awareness of the importance of TR and its assessment and management are important, including referral of patients to tertiary heart valve centers.

• #1 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  The 2020 ACC/AHA guideline for the management of patients with valvular heart disease states that in patients with TR, a transthoracic echocardiogram (TTE) is a class 1 indication for the evaluation of the presence and severity of TR, as well as to determine the possible aetiology for TR, assess RV systolic function, measure the sizes of the right-sided chambers and inferior vena cava, estimate pulmonary artery systolic pressure, and characterise any associated left-sided heart disease. […] Mild TR has been estimated to be present in about 80% of the population and does not typically confer any negative prognosis. However, moderate to severe TR leads to significant morbidity and mortality. […] Indeed, there has been growing recognition of the prognostic value of the degree of TR as an isolated comorbidity.

• #1 Tricuspid regurgitation – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/472

  Mild or moderate tricuspid regurgitation without abnormal valve anatomy, ventricular function, or pulmonary artery pressure is not necessarily abnormal but is estimated to be present in over 50% of asymptomatic young adults. […] The disease has largely been undertreated and its impact is under appreciated.

• #1 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  The overall rate of surgical treatment for TR is low. […] In summary, of the multiple transcatheter approaches to address TV, several relatively small single-armed studies have demonstrated promise for TEER, annuloplasty, and valve replacement with durable results and favourable clinical outcomes at 1 year follow-up. […] Several randomised controlled trials are currently enrolling patients, randomising them to transcatheter approaches to tricuspid repair or replacement compared with medical therapy, with early results favouring TEER.

• #1 Tricuspid regurgitation: what is the real clinical impact and how often should it be treated? | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-regurgitation-what-is-the-real-clinical-impact-and-how-often-should-it-be-treated

  This has sparked the development of numerous percutaneous transcatheter devices to treat this large group of high surgical risk patients. […] If we are truly to make an impact on the natural history of TR and reduce periprocedural morbidity and mortality rates of TV intervention, it will require: A better understanding of TV disease as well as the predictors and timing of progression. […] Clinical and echocardiographic screening in certain high-risk groups of patients in order to recommend treatment before advanced TV and RV remodelling occurs. […] Proven safe and efficacious percutaneous therapies for patients considered high-risk for surgical intervention. […] An evidence base for earlier surgical or percutaneous intervention of significant TR irrespective of symptoms.

• #1 Tricuspid regurgitation – Part 1: evaluation and risk stratification

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-1-evaluation-and-risk-stratification

  With an ageing population and more minimally invasive treatment options available, the need to predict mortality, in order to adequately select patients who will benefit from an intervention or who are eligible for surgery, is crucial. […] There is no consensus about the best strategy and patient population for isolated TV interventions. […] Severe, symptomatic tricuspid regurgitation has an important impact on clinical outcomes and needs to be addressed early in order to improve symptoms and quality of life, therefore early referral to a specialised centre is of major importance.

• #1 The tricuspid valve in review: anatomy, pathophysiology and echocardiographic assessment with focus on functional tricuspid regurgitation – Yucel – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/38028/html

  Despite the negative impact on outcomes, based on the current AHA/ACC guidelines, the only class I indication for TV repair or replacement for severe functional TR is at the time of left-sided valve surgery. […] With the aging population, increased recognition of the impact of functional TR on outcomes, and novel therapeutic avenues, the interest in TV disease has been rekindled.

• #2 Tricuspid Regurgitation | Thoracic Key

  https://thoracickey.com/tricuspid-regurgitation/

  With respect to heart valve diseases, until recently tricuspid valve regurgitation has received less attention than aortic or mitral valve lesions and therefore has been referred to as the forgotten valve. […] Using echocardiography, the Framingham Heart Study investigators found a prevalence of moderate or severe tricuspid regurgitation of 0.8% and an increased prevalence with aging. Overall, the prevalence of significant tricuspid regurgitation was 4.3 times greater in females than in males. […] Finally, the development of hemodynamically significant tricuspid regurgitation has been reported in 27% of patients who had only mild tricuspid regurgitation at the time of left-sided valve surgery. […] It has been reported that increasing severity of tricuspid regurgitation is associated with worsening prognosis, independently from left ventricular function or pulmonary pressure.

• #2 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  Tricuspid regurgitation (TR) is a relatively common finding. There has been growing recognition of the morbidity and adverse prognosis of severe TR, which affects 1.6 million people in the US. […] However, symptomatic TR remains undertreated despite emerging therapeutic modalities. […] In this review, we discuss the pathophysiological and epidemiological aspects of TR, and provide a critical overview of the current and future directions of therapy focusing on novel percutaneous approaches. […] Severe tricuspid regurgitation (TR), which affects 1.6 million people in the US, leads to progressive right ventricular (RV) dilation and failure if left untreated. […] However, TR remains undertreated. […] Importantly, secondary or functional TR commonly reflects the presence of, and in turn aggravates, RV failure.

• #2 Tricuspid valve regurgitation: epidemiology and pathophysiology – Minerva Cardioangiologica 2018 December;66(6):673-9 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/minerva-cardiology-angiology/article.php?cod=R05Y2018N06A0673

  Compared with the vast literature concerning the prevalence, pathophysiology, and outcome of left valvular disease, the data concerning tricuspid regurgitation (TR) is very limited. […] We show that TR is as prevalent as aortic stenosis in the community, with increasing prevalence with age, and much more common in women. […] Finally, due to the heterogeneous nature of TR we review the outcome data for each presentation of TR and show that in most contexts TR is associated with very poor outcome, even when adjusted for left ventricular systolic, and diastolic function, pulmonary pressure, and RV dysfunction.

• #2 Tricuspid regurgitation: what is the real clinical impact and how often should it be treated? | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-regurgitation-what-is-the-real-clinical-impact-and-how-often-should-it-be-treated

  Tricuspid regurgitation (TR) is a frequently occurring valvular disease in the elderly population, the aetiology is functional in the vast majority of cases, and this valvular disease has become increasingly recognised as an independent predictor of morbidity and mortality. […] The Framingham Heart Study showed that the prevalence of clinically significant (i.e., moderate or severe) TR in the general population reached up to 5.6% of women and 1.5% of men older than 70 years. […] Thus, the already notable prevalence of significant TR will most likely increase dramatically in the near future. […] Recent epidemiological data indicate that FTR accounts for 90% of all-comers with severe TR, and in total 65% of FTR occurs in the context of pulmonary hypertension. […] The most cited article demonstrating the negative prognostic impact of FTR showed that, in a retrospective evaluation of 5,223 patients, mortality increased with increasing severity of TR.

• #2 Echocardiographic Evaluation of the Tricuspid Valve: A Quick and Updated Guide

  https://www.acc.org/Latest-in-Cardiology/Articles/2021/10/25/13/49/Echocardiographic-Evaluation-of-the-Tricuspid-Valve

  Tricuspid regurgitation (TR) is a common condition and its prevalence is only expected to increase with the aging population, rising rates of atrial fibrillation, and increased use of intracardiac devices (e.g., pacemakers). […] A contemporary cohort showed 4.5% of the community and 12% of hospitalized patients had significant TR (equal to moderate or greater severity), which increased to 23% among patients with heart failure with reduced ejection fraction (HFrEF). […] Over 90% of TR is due to functional etiologies, including left-sided valvular disease, pulmonary hypertension, left ventricular (LV) dysfunction, or dilation of the tricuspid apparatus resulting in an incompetent valve. […] TR is associated with heart failure hospitalizations (RR 1.73) and all-cause mortality (RR 1.61 and 3.44 for moderate and severe TR, respectively).

• #2 Frontiers | Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.713658/full

  Atrioventricular regurgitation is frequent in the setting of heart failure. […] Similarly, tricuspid regurgitation (TR) is recognised as a common valve disease, observed in more than 1.6 million individuals in the United States. More than 80% of TR encountered in clinical practise is secondary, related to either left-sided valvular diseases, chronic atrial fibrillation, or global heart failure. […] In the ESC-HF-LT Registry moderate to severe TR was equally prevalent among HF subtypes, affecting approximately 20 % of the patients with HF. […] In a large cohort of patients with HFrEF, increasing TR severity was independently associated with considerably worse prognosis. Five-year survival was only 45 ± 2% for moderate TR, and 34 ± 4% for severe TR. […] Interestingly, the independent impact of TR on mortality was sustained whatever the ejection fraction was.

• #2 Etiology, epidemiology, pathophysiology and management of tricuspid regurgitation: an overview

  https://www.imrpress.com/journal/RCM/22/4/10.31083/j.rcm2204122

  Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men. […] Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target.

• #2 Natural course of tricuspid regurgitation and prognostic implications | Open Heart

  https://openheart.bmj.com/content/8/1/e001529

  Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR. […] TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) and left ventricular ejection fraction (LV-EF). […] While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival. […] This is the first study to assess TR and its natural course according to quantitative echocardiographic measures, including measurement of TR and the right ventricle in particular. We identified TR grade, RV dysfunction, pulmonary pressure and TR progression as independent predictors for survival besides known risk factors such as left ventricular ejection fraction, NT-proBNP, aortic stenosis, type 2 diabetes and atrial fibrillation. […] Moderate and severe TR had prognostic value irrespective of sPAP and LV-EF. However, survival was lowest in patients with concomitant elevated sPAP and reduced LV-EF. […] Patients with TR progression showed significantly worse survival.

• #2 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  The 2020 ACC/AHA guideline for the management of patients with valvular heart disease states that in patients with TR, a transthoracic echocardiogram (TTE) is a class 1 indication for the evaluation of the presence and severity of TR, as well as to determine the possible aetiology for TR, assess RV systolic function, measure the sizes of the right-sided chambers and inferior vena cava, estimate pulmonary artery systolic pressure, and characterise any associated left-sided heart disease. […] Mild TR has been estimated to be present in about 80% of the population and does not typically confer any negative prognosis. However, moderate to severe TR leads to significant morbidity and mortality. […] Indeed, there has been growing recognition of the prognostic value of the degree of TR as an isolated comorbidity.

• #2 Tricuspid Regurgitation Diagnosis, Imaging, and Management: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/02/14/18/tricuspid-regurgitation-from

  Tricuspid regurgitation (TR) is prevalent and associated with high mortality but underdiagnosed and profoundly undertreated by surgery. […] Surveillance with transthoracic echocardiography (TTE) after a surgical or transcatheter intervention typically is performed before discharge; 1 month, 6 months, and 1 year after intervention, and then yearly. […] Awareness of the importance of TR and its assessment and management are important, including referral of patients to tertiary heart valve centers.

• #3 Tricuspid valve regurgitation | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tricuspid-valve-regurgitation-1?embed_domain=staging.radpair.comfavicon.icofavicon.ico&lang=gb

  The prevalence of moderate or severe tricuspid regurgitation is 0.8%, with this prevalence increasing with ageing. Women are 4.3 times more likely to be affected. […] The decision to treat tricuspid regurgitation is based on the aetiology and severity. Management involves pharmacotherapy measures (especially diuretics) and consideration of surgery. Surgery is generally recommended if there are signs of pulmonary hypertension, in which case tricuspid valve repair or tricuspid valve replacement may be necessary.

• #3 Tricuspid regurgitation: what is the real clinical impact and how often should it be treated? | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-regurgitation-what-is-the-real-clinical-impact-and-how-often-should-it-be-treated

  Tricuspid regurgitation (TR) is a frequently occurring valvular disease in the elderly population, the aetiology is functional in the vast majority of cases, and this valvular disease has become increasingly recognised as an independent predictor of morbidity and mortality. […] The Framingham Heart Study showed that the prevalence of clinically significant (i.e., moderate or severe) TR in the general population reached up to 5.6% of women and 1.5% of men older than 70 years. […] Thus, the already notable prevalence of significant TR will most likely increase dramatically in the near future. […] Recent epidemiological data indicate that FTR accounts for 90% of all-comers with severe TR, and in total 65% of FTR occurs in the context of pulmonary hypertension. […] The most cited article demonstrating the negative prognostic impact of FTR showed that, in a retrospective evaluation of 5,223 patients, mortality increased with increasing severity of TR.

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