Natural history of tricuspid regurgitation, a single center cohort analysis

High severity of tricuspid valve regurgitation (TR) is associated with poor clinical outcomes. However, the natural history of progression from less severe to more severe TR has not been well characterised.

A retrospective cohort analysis was performed on patients who underwent TTE from 2008-2024 on a single center. Patients with congenital heart disease or prior tricuspid valve intervention were excluded.

Of initial 28715 patients, 4807 (mean age 71 years) had serial TTE evaluation and were included for analysis. Median follow-up was 917 days (Interquartile range 326-1934 days). Patients were categorised by TR severity on initial TTE: 2051 (42.6%) had none/trace, 2092 (43,5%) were mild, 480 (9,9%) were moderate, and 184 (3,8%) were severe. At median follow up, progression to severe TR was seen in 0.1%, 1.5% and 12.0% of the none/trace, mild, and moderate groups, respectively (Log rank p<0.001). At 3600 days, progression to severe TR was seen in 17.95% of the moderate group. Patients with depressed LV function (LVEF<50%) were associated with greater risk of progression to severe TR compared to preserved LVEF (EF≥50%) (Relative Risk 2.8, 95% CI 2.01-3.7, Log rank p<0.001).

Moderate TR is associated with significant risk of progression to severe TR within 10 years. Patients presenting with moderate TR and LVEF< 50% were associated with increased risk of progression to severe TR. Further studies are required to determine if earlier identification and intervention on patients in this greater risk cohort can result in improved patient outcomes.