Tricuspid regurgitation in patients with severe mitral regurgitation and normal left ventricular ejection fraction: Risk factors and prognostic implications in a cohort of 895 patients

Background and aim of the study: Although tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR), its frequency, determinants and prognostic implications in those with severe MR and a normal left ventricular ejection fraction (LVEF) are not fully known. The study aim was to evaluate the risk factors for, and prognostic implications of, TR in patients with severe MR and a normal LVEF. Methods: In this retrospective cohort study, the authors' echocardiographic database for the period between 1993 and 2003 was screened for patients with severe MR and LVEF ≥55%. Chart reviews were performed for clinical, pharmacological and surgical details, while survival was analyzed as a function of TR severity. Results: Among 895 patients with severe MR and normal LVEF, 510 (57%) had grade ≥2+ TR, while 219 (24%) had grade 3 or 4+ TR. Those patients with grade ≥2+ TR were older (p <0.0001), more likely to be female (p <0.0001), and had a higher right ventricular systolic pressure (RVSP) (p <0.0001). After adjusting for group differences (except for atrial fibrillation), grade ≥2+ TR was associated with a higher mortality (relative risk 1.4, 95% confidence interval 1.1-1.8, p = 0.02). Mitral valve surgery was associated with a better survival in those with grade ≥2+TR (p = 0.0003). Conclusion: Significant TR is a frequent occurrence in patients with severe MR and a normal LVEF, and is associated with older age, female gender, and a higher RVSP. TR is independently associated with a higher mortality, while mitral valve surgery seems to offer a survival benefit.