{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:33:10Z","timestamp":1789702390434,"version":"4.0.1"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["MCTIC\/CNPq 2018"],"award-info":[{"award-number":["MCTIC\/CNPq 2018"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,6,16]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 645 patients with RHD were enrolled, mean age of 47\u00b112 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95%\u2009CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95%\u2009CI 1.34 to 2.17), New York Heart Association functional class III\/IV (HR 2.57, 95%\u2009CI 1.54 to 4.30), right atrial area (HR 1.52, 95%\u2009CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95%\u2009CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002295","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T11:23:49Z","timestamp":1693567429000},"page":"e002295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical outcomes and progression rate of tricuspid regurgitation in patients with rheumatic mitral valve disease"],"prefix":"10.1136","volume":"10","author":[{"given":"M\u00f4nica M Costa","family":"Caldas","sequence":"first","affiliation":[{"name":"Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"},{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Antonio M","family":"Esteves","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno R","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Hung","sequence":"additional","affiliation":[{"name":"Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Levine","sequence":"additional","affiliation":[{"name":"Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente Resende","family":"Silva","sequence":"additional","affiliation":[{"name":"Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marildes Luiza","family":"Castro","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz Marina Tacuri","family":"Chavez","sequence":"additional","affiliation":[{"name":"Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luiz Padilha da","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Statistics, Universidade Federal do Paran\u00e1, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana Aguiar","family":"Mello","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Cunha","family":"Ruffo","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Barbosa","family":"Andrade","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Blacktown Hospital, University of Western Sydney, Westmead, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8260-9212","authenticated-orcid":false,"given":"Luiz Guilherme","family":"Passaglia","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Maria Vilas","family":"Freire","sequence":"additional","affiliation":[{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8801-1828","authenticated-orcid":false,"given":"Maria Carmo P","family":"Nunes","sequence":"additional","affiliation":[{"name":"Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"},{"name":"Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"2025081709570515000_10.2.e002295.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2025081709570515000_10.2.e002295.2","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/S0140-6736(16)00547-X","article-title":"Valvular aspects of rheumatic heart 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Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2023-002295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:57:13Z","timestamp":1755449833000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2023-002295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,9,1]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/openhrt-2023-002295"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2023-002295","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}