Multi-State Modeling of Tricuspid Regurgitation Disease Progression Rate Using an EHR-Integrated Natural Language Processing Platform

Authors Omar Khalique, MD, George Petrossian, MD, Newell Robinson, MD, Ziad Ali, MD, Dphil, Jaffar Khan, MD, David Cohen, MD, MSc, William Chung, MD, Lin Wang, MD, Miguel Sotelo, PhD; Paul Nona, MD; Loren Wagner, PhD; Chris Rogers, BS

Tricuspid regurgitation (TR) is recognized as a morbid disease with negative outcomes, but disease progression is poorly characterized. Understanding disease progression is crucial for optimizing patient outcomes and determining timing of intervention.

Cardiac Intelligence® (Mpirik, Tempus Labs) studied patients with TR at baseline between August 2018 to December 2021 with a follow up echo until May 2023. Demographic and Echo indices were parsed from the Echo report using natural language processing. The endpoint was progression to severe TR (“progression”), characterized using a multi-state Markov model.
Patients with a TV intervention after the index echo but before the follow up echo were excluded.

52,090 patients (93,335 echoes) were retrospectively analyzed and screened for TR, (8,041 mild; 1,005 mild-moderate; 1,230 moderate; 280 moderate-severe), with an average observation window of 557 days (range: 31-1723 days). 27% of patients that were moderate-severe at the time of their index echo experienced progression, and this was significantly higher (p<0.001) than the progression rates for moderate (10%), mild-moderate (4%) and mild TR (1%). Patients indexed at moderate-severe TR had 10, 16 and 24% probability of progression within 6 months, 1 year, and 2 years, respectively. However, the time to progression was not significantly different when comparing patients indexed at mild, mild-moderate, moderate, or moderate-severe TR (p=0.178). For example, the time to progress to severe TR from mild TR (n=72) was 1.64 years, while the time to progression from moderate-severe was 1.26 years. The average time patients stayed in mild TR was 2.65 years (95% CI 2.55-2.75), 2.3 years in moderate TR (95% CI 2.20-2.49), and 1.2 years in moderate-severe (95% CI 1.00-1.29).

The study findings provide insights on the progression of TR which can be incorporated into future efforts to assess frequency of follow up imaging. These findings highlight the importance of vigilant monitoring which can help guide future tricuspid intervention trials. Further research is needed to elucidate the underlying mechanisms influencing TR progression.