Prevalence, burden and echocardiographic features of moderate to severe tricuspid regurgitation: insights from a tertiary referral center

<b>Background</b>. Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center. <b>Methods</b>. A retrospective analysis was performed on 6,309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE). <b>Results</b>. A total of 2,336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1,649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III-IV (<i>p</i>=0.022) and on higher doses of loop diuretic (<i>p</i>=0.022) than those with only moderate TR. Multivariable analysis revealed that Blood Urea Nitrogen (BUN, <i>p</i>=0.031) and abnormal liver function blood tests (<i>p</i>=0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and Tricuspid Annular Plane Systolic Excursion were found to be independent predictors of mid-term NACE. <b>Conclusions</b>. The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.