The outcome of patients with severe tricuspid regurgitation by body mass index

Body mass index (BMI) is an independent, predictor of adverse outcomes among patients with cardiovascular diseases. Our aim was to evaluate how BMI modifies the association of severe tricuspid regurgitation (TR) with poor survival.

Consecutive echocardiographic reports linked to clinical data from a tertiary medical center (2007-2021) were reviewed. BMI was stratified to underweight, normal weight, overweight, and obesity with cutoffs of 18.5, 25, and 30 Kg/m2. Multivariable Cox regression models were applied to calculate adjusted hazard ratios (aHR) for all-cause mortality.

The study population included 111,830 patients with a median age of 65 (IQR 52-76) years (58% males), 3436 (3.1%) patients had severe TR. There were 2398 (2%), 40,393 (36%), 43,790 (39%), and 25,249 (24%) individuals with underweight, normal weight, overweight, and obesity, respectively. During a median follow-up of 6 (3-10) years, 29,921 (27%) patients died. There was an interaction between BMI and TR with the outcome (p < 0.01). Severe TR was associated with mortality for patients with normal weight, overweight, and obesity, with an HR of 1.29 (95% CI 1.20-1.39), 1.26 (1.16-1.37), and 1.28 (1.15-1.43), respectively. This association was not evident among patients with underweight with an HR of 0.88 (0.64-1.22). Sub-analysis of hospitalized patients, with adjustment of the model to baseline comorbidities, including frailty, yielded similar point estimates to the main analysis.

The association of severe TR with mortality is modified by BMI group. Severe TR is associated with mortality among patients of all BMI groups, except for individuals with underweight.