Prognostic value of hemodynamically significant secondary tricuspid regurgitation in patients hospitalised for heart failure with preserved ejection fraction

Abstract Introduction Heart Failure with preserved ejection fraction (HFpEF) is a significant clinical concern, characterized by a rising prevalence and substantial morbidity. Despite the frequent presence of secondary tricuspid regurgitation (TR) in this population, its prognostic implications remain unknown. Purpose The aim of this study is to assess the rate of the composite of mortality and heart failure readmissions by considering the presence of hemodynamically significant secondary TR in patients hospitalised for HFpEF. Methods Prospective observational cohort study. Patients admitted for acute HFpEF (ejection fraction > 50%) between September 2019 to December 2022 were included. Patients with primary TR, pacemaker, moderate-severe left valve disease, end-stage renal failure (creatinine clearance < 30 ml/min/BSA) and recent myocardial infarction were excluded. TR was considered significant if rated as moderate or higher, following established semi-quantitative and quantitative criteria in current guidelines. Patients were followed-up for one year to assess the incidence of the composite primary outcome of death and heart failure readmission. Results A total of 110 patients were included. Median age was 85 [78-89] years, 64% were female. The mean left ventricle ejection fraction was 57% (+/-5%). Significant TR was observed in 44.5% (n=49) of cases. Patients with significant TR had higher NT-ProBnp values (4555 [2620-7025] pg/mL vs 2400 [1300-5494] pg/mL; P = 0.01), and worse echocardiographic parameters of right heart size and function compared to those without significant TR (TABLE). The incidence of the composite outcome was higher in patients with significant TR compared to patients without significant TR (P = 0.01, LogRank test) (FIGURE). In a Cox regression multivariate analysis including age and sex, significant TR was independently associated with the incidence of the primary outcome (HR 1.86; CI 1.10 - 3.13; P = 0.006). Conclusion In patients hospitalised for HFpEF, significant TR was independently associated with a higher incidence of death and heart failure readmission at one year-follow-up. Further research is needed in this group, particularly to explore novel risk stratification and therapeutic approaches.Kaplan-Meier curveTable