Author + information
- Received December 13, 2019
- Revision received February 10, 2020
- Accepted February 17, 2020
- Published online July 27, 2020.
- Marlieke F. Dietz, MDa,
- Edgard A. Prihadi, MDa,b,
- Pieter van der Bijl, MB, ChB, MMeda,
- Nina Ajmone Marsan, MDa,
- Victoria Delgado, MDa and
- Jeroen J. Bax, MDa,∗ ()
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDepartment of Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands.
Objectives The purpose of this study was to evaluate the prognostic value of staging right heart failure (RHF) in patients with significant secondary tricuspid regurgitation (TR).
Background Right ventricular dysfunction (RVD), defined as tricuspid annular plane systolic excursion <17 mm and clinical signs of RHF, defined as New York Heart Association functional class ≥II, peripheral edema, or use of diuretics, do not always coincide in patients with significant secondary TR and may have different prognostic implications.
Methods A total of 1,311 patients with significant secondary TR (median age: 71 [interquartile range: 62 to 78] years; 50% male) were divided into 4 RHF Stages according to the presence or absence of RVD and clinical signs of RHF: Stage 1 was defined as no RVD and no signs of RHF; Stage 2 indicated RVD but no signs of RHF; Stage 3 included RVD and signs of RHF; Stage 4 was defined as RVD and refractory signs of RHF at rest. Five-year mortality rates were compared across the 4 Stages of RHF, and the independent associates of mortality were identified by using multivariate Cox proportional hazards models.
Results A total of 101 patients (8%) were classified as Stage 1, 124 (10%) as Stage 2, 683 (52%) as Stage 3, and 403 (31%) as Stage 4. Patients in higher Stages of RHF had more comorbidities and worse renal and left ventricular systolic function. Cumulative 5-year survival was 54%. RHF Stages 3 and 4 were independently associated with increased mortality compared to Stage 1 (hazard ratio: 2.110 [95% confidence interval (CI): 1.163 to 3.828] and 3.318 [95% CI: 1.795 to 6.133], respectively).
Conclusions In patients with significant secondary TR, higher Stages of RHF are independently associated with all-cause mortality at long-term follow-up.
Supported by an unrestricted research grant from Edwards Lifesciences (IISUSTHV2018017) and by research grants from Abbott Vascular, Bioventrix, Medtronic, Biotronik, Boston Scientific, and GE Healthcare to the Department of Cardiology of the Leiden University Medical Center. Drs. Bax and Ajmone Marsan have received speaker fees from Abbott Vascular. Dr. Delgado has received speaker fees from Abbott Vascular, Medtronic, Edwards Lifesciences, and GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received December 13, 2019.
- Revision received February 10, 2020.
- Accepted February 17, 2020.
- 2020 American College of Cardiology Foundation
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