Liver-related outcomes in patients with tricuspid regurgitation
J Zhang, K H YiuAbstract
Aims
The natural history of hepatic involvement in tricuspid regurgitation (TR) remains undercharacterized. We aimed to assess the incidence and risk of liverrelated outcomes associated with TR severity, and to identify the predictors and survival impact of cirrhosis in patients with ≥moderate TR.
Methods
From 2004 to 2022, adults with documented TR severity were retrospectively included. Liver-related outcomes including cirrhosis, hepatocellular carcinoma (HCC), and liver-related death were followed longitudinally.
Results
Among 41,950 patients without prevalent liver disease, 7,226 (17.3%) had ≥moderate TR. The median follow-up was 6.4 years. Incidence rates of cirrhosis, HCC and liver-related death in patients with ≥moderate TR were 4.54 (95% confidence interval [CI], 3.89-5.29), 1.25 (95% CI, 0.92-1.68), and 1.33 (95% CI, 0.99-1.77) per 1,000 person-years, respectively. Compared to no/trace TR, both moderate and severe TR were associated with an increased risk of cirrhosis, while risks of HCC and liver-related death did not differ statistically across TR severity groups. Among patients with ≥moderate TR, independent predictors of cirrhosis were heart failure with preserved ejection fraction, right ventricular dysfunction, and cholestatic liver injury. Ventricular TR (hazard ratio [HR]: 2.33, 95% CI, 1.22-4.43, P=0.009) and lead-associated TR (HR: 2.66, 95% CI, 1.16-6.09, P=0.02) were associated with a higher risk of cirrhosis than atrial TR. Incident cirrhosis increased all-cause and cardiovascular death risks in patients with ≥moderate TR.
Conclusions
Significant TR is associated with incident cirrhosis, with risk varying by etiology. The development of cirrhosis portends a worse survival, supporting more comprehensive hepatic evaluation during TR management.Graphic Abstract