Characteristics and Prognostic Impact of Concomitant Tricuspid Regurgitation in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Introductions: Previous studies have shown that concomitant presence of tricuspid regurgitation (TR) was associated with poor prognosis in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). Nonetheless, another report suggested that impact of TR was affected by mitral regurgitation (MR) severity. We aim to investigate the imaging characteristics of concomitant TR according to the MR severity and its prognostic impact in patients who underwent TAVI. Methods: We studied 129 patients with severe AS who underwent TAVI from 2015 to 2020 (mean age 84 years; male 33%). We subdivided patients according to the presence of TR and MR (≥ moderate) and compared the imaging characteristics and prognosis. Results: Significant TR was observed in 25 patients (19%); among those with TR, 15 had both MR and TR and remaining 10 had only TR (Figure A). Patients with TR showed impaired right ventricular (RV) systolic function and higher tricuspid annulus area and RV end-diastolic volume (p < 0.05 for all). When we further compare the characteristics of patients with TR according to the MR severity, RV systolic function, tricuspid annulus area, or RV volume were similar regardless of the MR severity, while left ventricular (LV) volume was significantly smaller in patients with significant TR alone. During the follow-up, 15 patients experienced all-cause death. Patients with TR alone showed poorer all-cause mortality (Log-rank p = 0.008; Figure B). In multivariable Cox proportional-hazards model, TR was independently associated with all-cause mortality in the absence of MR (hazard ratio 4.94, p = 0.008). Conclusions: In patients undergoing TAVI, significant TR was associated with advanced RV remodeling regardless of MR status, while patients who only exhibited TR had less LV remodeling. Concomitant TR was associated with poorer outcome in the absence of MR, indicating that could be an independent risk factor in patients undergoing TAVI.