Change of Tricuspid Regurgitation Velocity as a Biomarker for All-Cause Mortality

Corresponding Author

Increasing age is physiologically associated with an increase in TRV, even though regurgitation severity may be trivial to mild. 2  The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate.For more information, visit the Author Center.Whether transcatheter intervention will improve mortality will remain to be demonstrated.According to the present work, halting TRV progression may be enough.

FUNDING SUPPORT AND AUTHOR DISCLOSURES
Dr Lang has received funding from the Vienna Science and Technology Fund WWTF LS18-090; has relationships with drug companies including AOP-Health, Actelion-Janssen, MSD, United Therapeutics, Medtronic, and Neutrolis; and in addition to being investigator in trials involving these companies, she has relationships that include consultancy service, research grants, and membership of scientific advisory boards.Dr Skoro-Sajer has received compensation for scientific symposia from AOP-Health, Actelion-Janssen, MSD, Cordis, Medtronic, GlaxoSmithKline, and United Therapeutics.Tricuspid Regurgitation and Mortality

ADDRESS FOR CORRESPONDENCE
However, increased vena cava back flow through the tricuspid valve may be a clinical hallmark of dysfunctional right ventricular to pulmonary arterial coupling, or right ventricular to vena cava coupling 3 and may occur as a consequence of a multitude of conditions.Principally, pulmonary vascular diseases, right ventricular myocardial dysfunction and primary tricuspid valve disease may account for increased TRV.Furthermore, increased TRV may occur whenever right ventricular preload or afterload is increased acutely and transiently, or chronically.Acutely increased TRV may result from intravascular volume loading through fluid administration, due to an increase in osmotic pressure, due to renal dysfunction, or during external chest compression and in systemic disease conditions.The present study by Kholdani et al 4 in this issue of JACC: Advances aimed to determine the predictors and clinical significance of TRV progression, regardless of the cause.Authors found that older age, depressed left ventricular ejection fraction, diabetes, hypertension, hyperlipidemia, atrial fibrillation, heart failure, and chronic kidney disease were associated with faster progression of TRV, and those with TRV progression of >0.23 m/s/y had an increased risk of all-cause mortality.Although the importance of tricuspid regurgitation (TR)-derived pulmonary artery pressure estimates for survival has long been recognized 5,6 and introduced into clinical risk scores, 7,8 there are several new messages in this present work.First, the authors should be commended on taking an effort to look at the tricuspid valve from a global perspective.Elegant modern reviews on the tricuspid valve either take an in-depth and focused look at tricuspid valve anatomy and function, or at modern imaging features, 9,10 classifying primary, atrial, ventricular, and device-induced functional TR, putting aside pulmonary vascular disease, systemic disease, and effects of acute loading conditions on the right ventricle.Second, authors introduce the concept of annual change in velocity as a predictor of outcome, compared with static TR, 6 adding a new dimension to linear thresholds.Annual progression has been well studied in other valve disease, for example, in degenerative aortic valve stenosis annual progression >3 mm Hg/s/y was associated with worse outcomes. 11However, in contrast to aortic valve stenosis, TRV is a less organic but more functional condition that may regress as the underlying cause disappears.Along these lines, in the present study, ISSN 2772-963X https://doi.org/10.1016/j.jacadv.2023.100576*Editorials published in JACC: Advances reflect the views of the authors and do not necessarily represent the views of JACC: Advances or the American College of Cardiology.From the Division of Cardiology, Department of Internal Medicine II, Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria.
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replacing the old mean invasively assessed pulmonary artery pressure threshold of $25 mm Hg.5While this appears counterintuitive, the current work demonstrates that absolute TRV >2.8 m/s was associated with worse overall prognosis with mortality rates of 32.6% amongst those with a TRV tients and healthcare.With the rapid development of transcatheter solutions which have shown safety and efficacy, there is a growing interest in TR.