Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation
Abstract Aims Functional tricuspid regurgitation (FTR) associated with degenerative mitral regurgitation (DMR) accentuates the severity of heart failure and is a marker of poor prognosis. Little is known about FTR associated with asymptomatic DMR. Methods and results The study included 1249 asymptom...
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Wiley
2025-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15278 |
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| author | Christophe Tribouilloy Yohann Bohbot Benjamin Essayagh Giovanni Benfari Jeroen J. Bax Thierry Le Tourneau Yan Topilsky Clemence Antoine Dan Rusinaru Francesco Grigioni Nina Ajmone Marsan Aniek vanWijngaarden Aviram Hochstadt Jean Christian Roussel Prabin Thapa Michelena Hector I Maurice Enriquez‐Sarano |
| author_facet | Christophe Tribouilloy Yohann Bohbot Benjamin Essayagh Giovanni Benfari Jeroen J. Bax Thierry Le Tourneau Yan Topilsky Clemence Antoine Dan Rusinaru Francesco Grigioni Nina Ajmone Marsan Aniek vanWijngaarden Aviram Hochstadt Jean Christian Roussel Prabin Thapa Michelena Hector I Maurice Enriquez‐Sarano |
| author_sort | Christophe Tribouilloy |
| collection | DOAJ |
| description | Abstract Aims Functional tricuspid regurgitation (FTR) associated with degenerative mitral regurgitation (DMR) accentuates the severity of heart failure and is a marker of poor prognosis. Little is known about FTR associated with asymptomatic DMR. Methods and results The study included 1249 asymptomatic patients with moderate or severe DMR from the Mitral Regurgitation International Database‐Quantitative (MIDA‐Q) registry (mean age 64 ± 15 years, 25% female). Despite the asymptomatic status, absent/trivial FTR was noted in only 42%, mild in 34.5%, moderate in 11%, and severe FTR in 12.5%. Patients with higher FTR grades were older and more often female and had higher EuroScore II, larger left atrial volumes, and more atrial fibrillation (all P < 0.05). Patients with moderate or severe FTR had comparable 5‐year survival (64 ± 4% and 65 ± 4%) and lower than patients with no/trivial FTR(96 ± 1%, P < 0.001). After adjustment for key prognostic factors, including age, left ventricular dilatation and dysfunction, DMR severity, left atrial dilatation, and pulmonary hypertension, ≥moderate FTR remained a strong predictor of mortality (HR = 2.08 [1.17–3.72], P = 0.013). Sensitivity analysis showed stable impact of ≥moderate FTR among patients with/without pulmonary hypertension, in women and men and for any other subset. For patients who underwent mitral valve surgery, post‐operative survival rates were similar between those with no/trivial FTR and those with ≥moderate or severe FTR (P = 0.76), suggesting that surgery could reduce the excess mortality related to preoperative FTR. Conclusions Among asymptomatic patients with significant DMR, ≥moderate FTR is frequent and independently associated with higher mortality, independently of traditional guideline‐based risk factors. These findings suggest that ≥moderate FTR should lead to consideration of early mitral surgery to improve outcomes. |
| format | Article |
| id | doaj-art-767aa51992874639ad27a8a1eaa02df8 |
| institution | DOAJ |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-767aa51992874639ad27a8a1eaa02df82025-08-20T03:15:34ZengWileyESC Heart Failure2055-58222025-08-011242591259610.1002/ehf2.15278Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitationChristophe Tribouilloy0Yohann Bohbot1Benjamin Essayagh2Giovanni Benfari3Jeroen J. Bax4Thierry Le Tourneau5Yan Topilsky6Clemence Antoine7Dan Rusinaru8Francesco Grigioni9Nina Ajmone Marsan10Aniek vanWijngaarden11Aviram Hochstadt12Jean Christian Roussel13Prabin Thapa14Michelena Hector I15Maurice Enriquez‐Sarano16Department of Cardiology Amiens University Hospital Amiens FranceDepartment of Cardiology Amiens University Hospital Amiens FranceDivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USADivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USADepartment of Cardiology Leiden University Medical Center Leiden The NetherlandsDepartment of Cardiology University of Nantes Nantes FranceDepartment of Cardiology, Faculty of Medicine Tel Aviv Medical Center and Sackler Tel Aviv IsraelDivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USADepartment of Cardiology Amiens University Hospital Amiens FranceDepartment of Cardiology University Campus Bio‐Medico Rome ItalyDepartment of Cardiology Leiden University Medical Center Leiden The NetherlandsDepartment of Cardiology Leiden University Medical Center Leiden The NetherlandsDepartment of Cardiology, Faculty of Medicine Tel Aviv Medical Center and Sackler Tel Aviv IsraelDepartment of Cardiology University of Nantes Nantes FranceDivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USADivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USADivision of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USAAbstract Aims Functional tricuspid regurgitation (FTR) associated with degenerative mitral regurgitation (DMR) accentuates the severity of heart failure and is a marker of poor prognosis. Little is known about FTR associated with asymptomatic DMR. Methods and results The study included 1249 asymptomatic patients with moderate or severe DMR from the Mitral Regurgitation International Database‐Quantitative (MIDA‐Q) registry (mean age 64 ± 15 years, 25% female). Despite the asymptomatic status, absent/trivial FTR was noted in only 42%, mild in 34.5%, moderate in 11%, and severe FTR in 12.5%. Patients with higher FTR grades were older and more often female and had higher EuroScore II, larger left atrial volumes, and more atrial fibrillation (all P < 0.05). Patients with moderate or severe FTR had comparable 5‐year survival (64 ± 4% and 65 ± 4%) and lower than patients with no/trivial FTR(96 ± 1%, P < 0.001). After adjustment for key prognostic factors, including age, left ventricular dilatation and dysfunction, DMR severity, left atrial dilatation, and pulmonary hypertension, ≥moderate FTR remained a strong predictor of mortality (HR = 2.08 [1.17–3.72], P = 0.013). Sensitivity analysis showed stable impact of ≥moderate FTR among patients with/without pulmonary hypertension, in women and men and for any other subset. For patients who underwent mitral valve surgery, post‐operative survival rates were similar between those with no/trivial FTR and those with ≥moderate or severe FTR (P = 0.76), suggesting that surgery could reduce the excess mortality related to preoperative FTR. Conclusions Among asymptomatic patients with significant DMR, ≥moderate FTR is frequent and independently associated with higher mortality, independently of traditional guideline‐based risk factors. These findings suggest that ≥moderate FTR should lead to consideration of early mitral surgery to improve outcomes.https://doi.org/10.1002/ehf2.15278Degenerative mitral regurgitationFunctional tricuspid regurgitationOutcomeSurvivalSurgery |
| spellingShingle | Christophe Tribouilloy Yohann Bohbot Benjamin Essayagh Giovanni Benfari Jeroen J. Bax Thierry Le Tourneau Yan Topilsky Clemence Antoine Dan Rusinaru Francesco Grigioni Nina Ajmone Marsan Aniek vanWijngaarden Aviram Hochstadt Jean Christian Roussel Prabin Thapa Michelena Hector I Maurice Enriquez‐Sarano Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation ESC Heart Failure Degenerative mitral regurgitation Functional tricuspid regurgitation Outcome Survival Surgery |
| title | Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| title_full | Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| title_fullStr | Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| title_full_unstemmed | Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| title_short | Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| title_sort | prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation |
| topic | Degenerative mitral regurgitation Functional tricuspid regurgitation Outcome Survival Surgery |
| url | https://doi.org/10.1002/ehf2.15278 |
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