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Original research
Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation
  1. Sahrai Saeed1,2,
  2. Jenna Smith2,
  3. Karine Grigoryan2,
  4. Stig Urheim1,
  5. John B Chambers2 and
  6. Ronak Rajani2
  1. 1 Department of Heart Disease, Haukeland Universitetssjukehus, Bergen, Norway
  2. 2 Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sahrai Saeed; sahrai.saeed{at}


Objectives The true prevalence and disease burden of moderate or severe (significant) tricuspid regurgitation (TR) in patients undergoing routine echocardiography remains unknown. Our aim was to explore the prevalence of significant TR and the impact of pulmonary hypertension (PH) on outcome in a less selected cohort of patients referred to echocardiography.

Methods From 12 791 echocardiograms performed between January and December 2010, a total of 209 (1.6%) patients (72±14 years, 56% men) were identified with significant TR; 123 (0.96%) with moderate and 86 (0.67%) with severe TR. Median follow-up time was 80 months (mean 70±33 months). Systolic pulmonary artery pressure was derived from peak velocity of tricuspid regurgitant jet plus the right atrial pressure and considered elevated if ≥40 mm Hg (PH).

Results During follow-up there were 123 (59%) deaths with no difference in mortality between moderate and severe TR (p=0.456). The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p<0.001). PH was associated with lower event-free survival in moderate (log-rank, p<0.001), 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).

Conclusions Moderate or severe TR was found in 1.6% of patients attending for routine echocardiograms. PH identified a high-risk subset of patients with moderate TR but not with severe TR.

  • tricuspid valve
  • tricuspid valve regurgitation
  • pulmonary hypertension
  • prognosis
  • transthoracic echocardiography

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  • Contributors SS and RR contributed to study design, acquisition, analysis and interpretation of data, writing the article and final approval. JS and KG contributed to acquisition of data and revising the article. SU contributed to interpretation of data and revising the article. JBC contributed to interpretation of data, revising the article for important intellectual content and final approval.

  • Funding Bergesenstiftelsen provided financial support for SS to conduct this study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the NHS Health Research Authority and the local Institutional Review Board (study protocol ID 260396/2019).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.

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