ArticleReviews in cardiovascular medicine2026
A Pathophysiology-Integrated Nomogram to Predict Tricuspid Regurgitation Progression After Isolated Mitral Valve Surgery: A Retrospective Cohort Study.
Article in Reviews in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Functional tricuspid regurgitation (FTR) frequently progresses after isolated mitral valve (MV) surgery in patients with pre-existing annular dilation, leading to adverse long-term outcomes. Notably, current guideline recommendations for concomitant tricuspid valve intervention, based primarily on annular size, lack precision for individualized risk prediction and may lead to both overtreatment and undertreatment. Methods: This retrospective, single-center cohort study included 398 patients with mild FTR and tricuspid annular dilation (>40 mm) who underwent isolated MV surgery (2010-2018). The primary endpoint was progression to at least moderate tricuspid regurgitation (TR) on the follow-up echocardiography. Multivariable logistic regression identified independent predictors. A nomogram was developed and internally validated via bootstrapping. Model performance was assessed using discrimination (area under the curve [AUC]), calibration (calibration plots and mean absolute error), and clinical utility (decision curve analysis [DCA] and clinical impact curve [CIC]). Results: TR progression occurred in 119 patients (29.9%) over a median follow-up of 5.2 years (interquartile range: 3.1-7.4). Multivariable analysis identified four independent preoperative predictors: atrial fibrillation type (paroxysmal: odds ratio [OR] 2.764, 95% confidence interval [CI] 1.682-4.532; persistent: OR: 3.422, 95% CI: 2.081-5.625; permanent: OR: 2.345, 95% CI: 1.404-3.917; all Conclusions: This study developed and internally validated a pathophysiology-integrated nomogram accurately predicting the risk of TR progression after isolated MV surgery. This tool, which incorporates readily available preoperative variables, facilitates personalized risk stratification and evidence-based decision-making regarding concomitant tricuspid intervention, thereby potentially optimizing long-term outcomes for patients with functional tricuspid regurgitation.
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