Cardiology AdvisorSurvival Rates Differ by Etiology in Moderate or More Severe Tricuspid Regurgitation

ℹ️ Observational Association Only Evidence
A 12,899-patient Mayo Clinic retrospective cohort found median survival differed substantially by tricuspid regurgitation etiology: 5.7 years for primary TR, 3.6 years for secondary TR, and 3.4 years for lead-associated TR. Differences persisted after adjustment for age, sex, and TR severity, and findings did not establish causality given the observational design.

Clinical Considerations

• The cohort was dominated by secondary TR (90.1%), with lead-associated TR at 6.9% and primary TR at 3.0%; mean ages spanned 68 to 73 years.
• Adjusted hazard ratios versus PTR: STR 1.4 (95% CI 1.2-1.6) and LTR 1.5 (95% CI 1.1-1.7); STR and LTR did not differ significantly from each other.
• The TRIO score independently associated with mortality across all three etiology groups and was the sole multivariable predictor in PTR (HR 2.49).
• In STR, RV dysfunction, pulmonary hypertension, peripheral vascular disease, and left-sided valve disease independently associated with mortality.

Practice Applications

• Recognize TR etiology as a key prognostic variable, not just severity grade.
• Integrate TRIO score into risk stratification for moderate or more severe TR.
• Monitor RV function and pulmonary hypertension closely in secondary TR.
• Consider lead-associated TR as carrying mortality risk comparable to secondary TR.

Related Summaries