Impact of the new classification of tricuspid regurgitation on the baseline characteristics and prognosis of a wide series of "real life" patients

TLDR: A new classification of severe tricuspid regurgitation (TR) has recently been described that distinguishes three subgroups: severe, massive and torrential as discussed by the authors , and the prevalence of the new categories, describe their baseline characteristics according to severity group and assess their impact on the prognosis in a large series of patients with severe TR.

Abstract: Type of funding sources: Foundation. Main funding source(s): Andalusian Society of Cardiology A new classification of severe tricuspid regurgitation (TR) has recently been described that distinguishes three subgroups: severe, massive and torrential. Our objective was to analyse the prevalence of the new categories, describe their baseline characteristics according to severity group and assess their impact on the prognosis in a large series of patients with severe TR of a tertiary care hospital in our area. All consecutive patients ≥18 years with severe TR studied with echocardiography in a tertiary care hospital in our area from 01.01.2008 to 12.31.2017 were retrospectively included. Images were analysed off-line to measure the maximum vena contracta (VC) in any echocardiographic plane and severe TR was classified into three groups: severe (VC≥7mm), massive (VC 14–20mm) and torrential (VC≥21mm). Baseline characteristics were analysed in the different subgroups and follow-up events by univariate and multivariate techniques. The combined event of death and heart failure (HF) admission on follow-up was investigated. A total of 661 patients (69±13 years, 72% women) with severe TR were included. 81.5% (539) presented severe TR, 15.6% (103) massive TR and 2.9% (19) torrential TR. The baseline characteristics were different according to the different subgroups of severity (Table). The 5-year HF-free survival was 42%, 44% and 11% (p<0.0005), for the different subgroups, respectively (Figure). After adjusting for baseline characteristics, the severity of TR assessed by VC was independent predictor of HF-free survival, HR 0.89 [95%CI 0.70–1.15] p = 0.39, for massive TR; and HR 2.48 [95% CI 1.52–4.05] p<0.0005, for torrential TR considering severe TR as reference. In this large monocentric study, severe TR measured by VC was the most frequent subgroup, followed by massive and torrential. The prognosis was significantly worse in patients with torrential TR.