Prognostic importance of significant secondary tricuspid regurgitation in rheumatic heart disease
P Chummee, N RatanasitAbstract
Background
Rheumatic heart disease remains a major contributor to valvular morbidity in many regions. While management strategies traditionally focus on left-sided valve lesions, secondary tricuspid regurgitation is frequently overlooked despite its high prevalence. Emerging evidence suggests that significant secondary tricuspid regurgitation may not be a benign bystander, yet its independent prognostic impact in patients with rheumatic heart disease has not been well established.
Purpose
To evaluate the prognostic impact of significant secondary tricuspid regurgitation in patients with rheumatic heart disease, with particular focus on all-cause mortality and the need for valvular interventions.
Methods
This retrospective cohort study included adult patients with rheumatic heart disease who underwent comprehensive transthoracic echocardiographic evaluation between 2014 and 2019. Patients were categorized according to the severity of secondary tricuspid regurgitation into significant (moderate to severe) and non-significant groups. The primary composite outcome comprised all-cause mortality and subsequent valvular interventions. Cox proportional hazards models were used to identify independent predictors of adverse outcomes.
Results
A total of 270 patients were included (mean age 54.5 ± 15.0 years; 75.9% female). Significant secondary tricuspid regurgitation was present in 45.9% (95% CI 39.9–51.9%). Over a median follow-up of 4.76 years, adverse outcomes occurred in 53.7% of patients, including 11 deaths and 138 valvular interventions. Patients with significant secondary tricuspid regurgitation experienced a significantly higher rate of adverse outcomes compared with those without (71.0% vs. 39.0%; P < 0.001). On multivariable analysis, significant secondary tricuspid regurgitation (HR 1.88, 95% CI 1.18–2.98) and New York Heart Association functional class III–IV (HR 2.74, 95% CI 1.80–4.18) were independent predictors of adverse outcomes.
Conclusion
Significant secondary tricuspid regurgitation is common in rheumatic heart disease and independently predicts adverse clinical outcomes. These findings challenge the traditional left-sided–focused approach and support more systematic assessment and earlier consideration of tricuspid valve management to improve long-term outcomes.Event-free survival of significant FTRVirtual abstract significant FTR in RHD