Prevalence, Clinical Correlates, and Prognostic Impact of Tricuspid Regurgitation in Older Adults: The ARIC Study

BACKGROUND: Tricuspid regurgitation (TR) is associated with older age and a heightened mortality rate. Limited data exist on TR prevalence and prognostic significance in community- based older adults. METHODS: Among 3046 participants in the ARIC (Atherosclerosis Risk in Communities) study who underwent echocardiography at the seventh study visit, TR severity was assessed as none/trace, mild, moderate, or severe by a board- certified cardiologist. Multivariable linear and logistic regression models assessed associations of TR severity with clinical characteristics, echocardiographic measures, and self- reported dyspnea. Multivariable Cox proportional hazard models evaluated associations with incident adjudicated heart failure (HF) and death. RESULTS: Mean age was 81±4 years, 58% were women, and 25% reported Black race. TR prevalence was 29% mild, 7% moderate, and 1% severe. Greater TR severity was associated with older age, female sex, prevalent HF, and worse cardiac structure and function. Associations with dyspnea were not statistically different in fully adjusted models. Over a median follow-u p of 3.7 (interquartile range, 2.6–4.3) years, there were 154 incident HF events and 412 deaths. Higher TR severity was associated with heightened risk of incident HF after adjusting for demographics, comorbidities, and measures of left ventricular structure and function (hazard ratio, 1.28 [95% CI, 1.01–1.64] per increment in severity category; P=0.04). Greater TR severity was associated with all-c ause death after adjusting for demographics (P=0.003) but not after further adjustment (P=0.3). CONCLUSIONS: TR is common in older adults and is associated with worse cardiac structure and function. Greater TR severity is independently associated with a greater risk of developing HF.