Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting

Abstract

OBJECTIVES This study sought to analyze patients with tricuspid regurgitation (TR) diagnosed in the community setting (Olmsted County) by Doppler echocardiography to define the prevalence, characteristics, and implications of clinically significant (greater or equal to moderate) TR. BACKGROUND The prevalence, cause distribution, and significance of TR are mostly unknown. METHODS All adult residents of Olmsted County, Minnesota, who underwent clinically indicated Doppler echocardiography between 1990 and 2000 were evaluated for presence of greater or equal to moderate TR. The characteristics and outcome of TR carriers was then analyzed. RESULTS During the study period, 417 community residents were diagnosed with greater or equal to moderate TR corresponding to an U.S. age- and sex-adjusted prevalence of 0.55% with 95% confidence interval (0.50 to 0.60). TR adjusted prevalence was higher in women (p < 0.01) and strongly linked to age (p < 0.0001). Isolated TR (without significant comorbidities, structural left valve disease, pulmonary hypertension, or overt cardiac cause) represented 8.1% of patients with greater or equal to moderate TR. Isolated TR adjusted for age, sex, ejection fraction, atrial fibrillation, and Charlson comorbidity index independently predicted higher mortality (adjusted risk ratio: 1.68; 95% confidence interval: 1.04 to 2.60; p = 0.03) for qualitative definition. Mortality in patients with greater or equal to moderate isolated TR was higher than in the matched cases with trivial TR (p = 0.0014; matching for age, sex, atrial fibrillation, ejection fraction, comorbidity index). Only 2.6% of patients ever had tricuspid valve surgery during follow-up. CONCLUSIONS Clinically significant (greater or equal to moderate) TR is common in community residents diagnosed by Doppler echocardiography and increases with age. Isolated TR is associated with excess mortality, thus TR represents an important public health problem.