Echocardiographic and Socioeconomic Predictors of Progression of Moderate Tricuspid Regurgitation: A Single Center Study

Journal of the American College of Cardiology Manuscript
Authors Maria Gabriela Gastanadui, Harish Ravipati, Miguel Sotelo, Chris Rogers, Loren Wagner, and Efstathia Andrikopoulou


Predictors of tricuspid regurgitation (TR) progression are poorly understood. We assessed echocardiographic (TTE), clinical and socioeconomic (SES) factors as predictors of progression from moderate to severe TR.


54,315 patients were retrospectively screened for moderate TR with an index TTE between 05/2017 to 10/2020 and a follow-up TTE at least 30 days after. Those with intracardiac device, tricuspid valve prosthesis/band/ring, at least moderate mitral regurgitation and/or aortic stenosis or regurgitation and history of Ebstein’s were excluded. Endpoint was progression to severe TR. Mpirik Cardiac Intelligence® and Natural Language Processing (NLP) screened TTE reports for numerical and language data. Zip code-linked census data (ZCCD) were extracted as SES indices. Univariate Cox proportional hazard model was performed.


529 patients were included. 22% progressed to severe TR (mean 390 ± 295 days; 56% of them progressed within the first year of follow up). Mean age was 67.37 ±15.7. 40% were male, 40% black and 43% had atrial fibrillation/flutter. Mean left ventricular ejection fraction was 51.6% ± 16%. Right ventricle systolic dysfunction and ZCCD as % black population, % population in poverty and average income were significant TR progression predictors (Figure 1).


SES and TTE markers correlated with higher risk of TR progression. Our analysis offers insights into the need for personalized echocardiographic monitoring of patients with moderate TR.