{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:55Z","timestamp":1753876315174,"version":"3.41.2"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Although significant tricuspid regurgitation (TR) is critically associated with heart failure (HF) prognosis, the predictors for large TR impact on HF outcomes remain unknown. This study aimed to identify echocardiographic predictors for a causal relation of TR to HF outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>In a retrospective, acute HF cohort of 462 patients, multivariate logistic regression analysis was performed to determine subgroups with strong association of greater-than-moderate TR with HF readmission or cardiovascular death in a year. We then conducted causal mediation analysis according to persistent atrial fibrillation (Af) or mitral regurgitation (MR) to identify the echocardiographic predictors. The association of TR with HF outcomes was prominent in subgroups of females, with Af, the enlarged indexed tricuspid annular diameter (TADi) or right atrial area, or within certain ranges of the left ventricular ejection fraction, indexed right ventricular end-systolic area, or fractional area change (FAC). Causal mediation analysis found that the TR impact was significant in patients with Af. Furthermore, combination of TADi \u22652.1 cm\/m2 and FAC \u226530%, which accounted for half of TR patients, predicted a much larger TR impact irrespective of Af and MR. Its prediction ability was superior to that of the modified Model for End-stage Liver Disease score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The causal impact and burden of TR on HF outcomes was significant in patients with Af, and combining TADi \u22652.1 cm\/m2 with FAC \u226530% could provide superior echocardiographic prediction of larger TR impact in HF patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjopen\/oeab027","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T15:14:04Z","timestamp":1632410044000},"source":"Crossref","is-referenced-by-count":1,"title":["Causal relation of tricuspid regurgitation for heart failure outcomes: a mediation analysis of echocardiographic predictors"],"prefix":"10.1093","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3143-8796","authenticated-orcid":false,"given":"Daihiko","family":"Hakuno","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Fukae","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Sueyoshi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jcmg.2018.06.014","article-title":"Burden of tricuspid regurgitation in patients diagnosed in the community setting","volume":"12","author":"Topilsky","year":"2019","journal-title":"J Am Coll Cardiol Imaging"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1093\/eurheartj\/ehs474","article-title":"Assessment of functional tricuspid regurgitation","volume":"34","author":"Badano","year":"2013","journal-title":"Eur Heart J"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1161\/CIRCIMAGING.111.967919","article-title":"Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension","volume":"5","author":"Topilsky","year":"2012","journal-title":"Circ Cardiovasc Imaging"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"e004897","DOI":"10.1161\/CIRCIMAGING.116.004897","article-title":"Functional tricuspid regurgitation caused by chronic atrial fibrillation: a real-time 3-dimensional transesophageal echocardiography study","volume":"10","author":"Utsunomiya","year":"2017","journal-title":"Circ Cardiovasc Imaging"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1093\/eurheartj\/ehaa192","article-title":"Functional tricuspid regurgitation of degenerative mitral valve disease: a crucial determinant of survival","volume":"41","author":"Essayagh","year":"2020","journal-title":"Eur Heart J"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.jcmg.2014.07.018","article-title":"Clinical outcome of isolated tricuspid regurgitation","volume":"7","author":"Topilsky","year":"2014","journal-title":"J Am Coll Cardiol Imaging"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1253\/circj.CJ-17-1334","article-title":"Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients","volume":"82","author":"Abe","year":"2018","journal-title":"Circ J"},{"key":"2023041318441091600_","first-page":"57","article-title":"Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation","volume":"8","author":"Porter","year":"1999","journal-title":"J Heart Valve Dis"},{"key":"2023041318441091600_","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1253\/circj.CJ-11-0718","article-title":"Progression of isolated tricuspid regurgitation late after left-sided valve surgery. 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