Prevalence and prognostic significance of tricuspid regurgitation across different heart failure entities

Isabel Mattig (Berlin)1, D. Frumkin (Berlin)1, E. Romero Dorta (Berlin)1, H. Kretzschmar (Berlin)1, A. Sommer (Berlin)1, A. M. Redel (Berlin)1, J. Buchstaller (Berlin)1, E. Pieske-Kraigher (Berlin)1, K. Stangl (Berlin)1, H. Dreger (Berlin)1

1Deutsches Herzzentrum der Charite (DHZC) Berlin, Deutschland


Introduction: Tricuspid regurgitation (TR) is a frequent consequence of left sided heart failure (HF) and associated with increased morbidity and mortality. However, comprehensive data on prevalence and prognostic significance of TR in different HF entities is still scarce. In this prospective, multicenter study, we aimed to evaluate the prevalence and prognostic impact of TR on patients across different HF entities.

Methods: Patients with HF with reduced (HFrEF), mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF) according to current guidelines of the European Society of Cardiology (ESC) were enrolled from 2020 to 2022 (NCT04570098). Inclusion criteria comprised a transthoracic echocardiography up to three months prior to study participation. Follow-up telephone calls were performed at three, six and twelve months. 

Results: A total of 994 patients with completed follow-up were analyzed. 33% of patients had HFrEF, 20% HFmrEF, and 47% HFpEF. Overall, 3% of HF patients suffered from torrential TR, 4% from massive TR, 9% from severe TR, 17% from moderate TR, 59% from mild TR and 8% had no TR. The prevalence of severe to torrential, moderate, mild, and no TR in different HF entities was as follows: 15%, 18%, 57%, and 11% in HFrEF, 17%, 18%, 57%, and 9% in HFmrEF, as well as 17%, 17%, 60%, and 6% in HFpEF, respectively. The prevalence of TR grades did not differ significantly between the HF groups. During the follow-up period of 365 days, 15% of all patients died. In detail, all-cause mortality was 26% in severe to torrential TR, 20% in moderate TR, 12% in mild TR, and 2% in patients without TR (p<0.001 for comparison of different TR grades, p<0.001 for association with mortality). The occurrence of a relevant TR was associated with a reduced survival in all HF entities but reached significance only in HFrEF and HFpEF patients.

Conclusion: All entities of HF showed a similar prevalence of different TR grades. More severe TR was associated with increasing rates of all-cause mortality in HF patients.
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