Natural evolution of tricuspid regurgitation

Tricuspid regurgitation (TR) is a prevalent valvular disease that increases mortality regardless of other cardiac factors. Its severity correlates with higher mortality, but its progression depends on the patient’s hemodynamic status and does not follow a linear pattern. Most studies on TR are retrospective, limiting the analysis of its natural progression and improvement. The lack of a structured follow-up protocol contributes to late diagnoses, complicating treatment and increasing morbidity. Studies indicate that rapid progression of TR is associated with higher mortality. Factors contributing to its progression include right ventricular (RV) dilation and dysfunction, pulmonary hypertension (PH), atrial fibrillation, and chronic kidney disease. Prolonged PH induces maladaptive remodeling in the RV, worsening TR and creating a vicious cycle that deteriorates ventricular function. The treatment of TR, primarily surgical, is recommended for patients with severe TR requiring left-sided valve surgery. However, isolated TR surgery has limited recommendations due to high in-hospital mortality. Medical treatments focus on decongestion and managing the underlying disease. Recently, percutaneous treatments like the TriClip have emerged, showing improvements in quality of life but no significant differences in mortality or heart failure hospitalizations. In conclusion, it is crucial to develop more rigorous follow-up strategies to detect TR progression and optimize the timing of intervention, thereby improving clinical outcomes.