BACKGROUND Significant tricuspid regurgitation (TR) is associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and clinical outcome. METHODS We studied 5,886 patients who were followed for a period of 10 years after the index echocardiographic examination. The relationship between TR severity and the end point of admission for heart failure or cardiovascular mortality was analyzed using competing risk analysis, Cox model, and propensity score matching. RESULTS Higher TR grade was associated with markers of LHD including left ventricular systolic dysfunction, valvular heart disease ≥ moderate, left atrial enlargement, and pulmonary hypertension (all P < .001). There was a significant interaction between TR and the presence of LHD with regard to the end point of heart failure in the competing risks model (P = .01) and the combined end point of heart failure and cardiovascular mortality (P = .02). In both models, moderate/severe TR was associated with higher risk for heart failure (hazard ratio [HR] = 3.10; 95% CI, 1.41-6.84; P = .005) and the combined end point of heart failure or cardiovascular mortality (HR = 2.75; 95% CI, 1.33-5.63, P = .006) only in patients without LHD. Propensity score matching yielded 350 patient pairs, of which 88% had LHD. The HR for heart failure or cardiovascular mortality at 10 years was 0.78 (95% CI, 0.56-1.08; P = .14) in the moderate/severe TR group as compared with the trivial/mild TR. CONCLUSIONS Moderate or severe functional TR portends an increased risk for heart failure and cardiovascular mortality only when isolated, without concomitant LHD.

中文翻译：

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左侧心脏病患者由于三尖瓣功能不全而导致心血管疾病的风险增加。

背景技术明显的三尖瓣关闭不全（TR）与不良心血管结果的较高风险相关。左侧心脏病（LHD）是这种关联的潜在重要混杂因素，因为它与TR和临床结局密切相关。方法我们研究了5886名在超声心动图检查后随访10年的患者。使用竞争风险分析，Cox模型和倾向评分匹配分析了TR严重程度与心力衰竭或心血管疾病死亡入院终点之间的关系。结果较高的TR等级与LHD的标志物有关，包括左心室收缩功能障碍，心脏瓣膜疾病≥中度，左心房扩大和肺动脉高压（所有P <.001）。在竞争风险模型中，关于心力衰竭的终点，TR和LHD的存在之间存在显着的相互作用（P = .01），而心力衰竭和心血管疾病的合并终点（P = .02）。在这两种模型中，中度/重度TR均与较高的心力衰竭风险相关（危险比[HR] = 3.10； 95％CI，1.41-6.84； P = .005）以及心力衰竭或心血管疾病的合并终点（ HR = 2.75; 95％CI，1.33-5.63，P = .006）仅适用于无LHD的患者。倾向得分匹配产生350对患者，其中88％为LHD。与轻度/轻度TR组相比，中度/重度TR组在10年时心力衰竭或心血管死亡率的HR为0.78（95％CI，0.56-1.08； P = .14）。