Tricuspid regurgitation (TR) is associated with an increased mortality. Previous studies have analyzed predictors of TR progression and the clinical impact of baseline TR. However, there is a lack of evidence regarding the natural history of TR: the pattern of change and clinical impact of progression. The authors sought to evaluate predictors of TR progression and assess the prognostic impact of TR progression. A total of 1,843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. All patients with less than a 2-year follow-up were excluded. Clinical and echocardiographic features, hospitalizations for heart failure, and cardiovascular death and interventions were recorded to assess their impact in TR progression. At a median 2.3-year follow-up, 19% of patients experienced progression. Patients with baseline moderate TR presented a rate progression of 4.9%, 10.1%, and 24.8% 1 year, 2 years, and 3 years, respectively. Older age (HR: 1.03), lower body mass index (HR: 0.95), chronic kidney disease (HR: 1.55), worse NYHA functional class (HR: 1.52), and right ventricle dilation (HR: 1.33) were independently associated with TR progression. TR progression was associated with an increase in chamber dilation as well as a decrease in ventriculoarterial coupling and in left ventricle ejection fraction ( 0.001). TR progression was associated with an increased cardiovascular mortality and hospitalizations for heart failure ( 0.001). Marked individual variability in TR progression hindered accurate follow-up. In addition, TR progression was a determinant for survival regardless of initial TR severity.

中文翻译：

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三尖瓣反流进展的决定因素及其对适当治疗的影响


三尖瓣反流（TR）与死亡率增加相关。先前的研究分析了 TR 进展的预测因素以及基线 TR 的临床影响。然而，缺乏关于 TR 自然史的证据：变化模式和进展的临床影响。作者试图评估 TR 进展的预测因素并评估 TR 进展的预后影响。共有 1,843 名至少患有中度 TR 的患者通过连续超声心动图研究和/或临床评估进行了前瞻性随访。所有随访时间少于 2 年的患者均被排除。记录临床和超声心动图特征、心力衰竭住院情况、心血管死亡和干预措施，以评估它们对 TR 进展的影响。在中位 2.3 年的随访中，19% 的患者出现病情进展。基线为中度 TR 的患者在 1 年、2 年和 3 年的进展率分别为 4.9%、10.1% 和 24.8%。年龄较大（HR：1.03）、较低体重指数（HR：0.95）、慢性肾病（HR：1.55）、较差的NYHA功能分级（HR：1.52）和右心室扩张（HR：1.33）与TR进展。 TR 进展与心室扩张增加以及心室动脉耦合和左心室射血分数降低相关 (0.001)。 TR 进展与心血管死亡率和心力衰竭住院率增加相关（0.001）。 TR 进展中明显的个体差异阻碍了准确的随访。此外，无论初始 TR 严重程度如何，TR 进展都是生存的决定因素。