Exercise-Induced Tricuspid Regurgitation
BACKGROUND: Exercise-induced preload/afterload changes could affect tricuspid regurgitation (TR). OBJECTIVES: The study aims to assess exercise-induced TR (exTR+), its consequences, and predictors. METHODS: Consecutive patients underwent exercise cardiac catheterization and three-dimensional echocardiography. ExTR+ was defined as a ≥1 grade increase in TR severity. RESULTS: ExTR+ occurred in 34% of 132 patients. Patients with exTR+ were older, had more atrial fibrillation, higher natriuretic peptides/heart failure with preserved ejection fraction probability scores, higher filling pressures, and lower cardiac output (P < 0.05). ExTR+ displayed greater right ventricular dilation, right atrial pressure rise, lower cardiac output, and lower oxygen consumption (P < 0.05). Exercise rather than resting TR regurgitant volume was more associated with cardiac output and oxygen consumption. Baseline TR, atrial fibrillation, and N-terminal pro-brain natriuretic peptide (OR: 1.065, 4.97, and 1.0004 per pg/mL, respectively, P < 0.05) predicted exTR+ (area under the curve: 0.91). CONCLUSIONS: ExTR+ is frequent, identifies heart failure with preserved ejection fraction-like phenotypes with a maladaptive exercise response, and adds information beyond resting TR.
Authors
- Fabio Previdi (ORCID: https://orcid.org/0000-0002-3713-7727)
- Gianfranco Parati (ORCID: https://orcid.org/0000-0001-9402-7439)
- Luigi Paolo Badano (ORCID: https://orcid.org/0000-0002-0379-3283)
- Jean‐Luc Vachiéry (ORCID: https://orcid.org/0000-0002-6358-7852)
- Denisa Muraru (ORCID: https://orcid.org/0000-0003-2514-3668)
- Claudia Baratto (ORCID: https://orcid.org/0000-0003-3472-4851)
- Ryan James Tedford (ORCID: https://orcid.org/0000-0001-9045-7722)
- Vishal N. Rao (ORCID: https://orcid.org/0000-0003-3545-4267)
- Michele Senni (ORCID: https://orcid.org/0000-0001-5502-7882)
- Marat Fudim (ORCID: https://orcid.org/0000-0002-8671-7007)
- Francesca Heilbron (ORCID: https://orcid.org/0000-0002-6682-573X)
- Sergio Caravita (ORCID: https://orcid.org/0000-0002-3003-6499)
- Luigi Fiocca (ORCID: https://orcid.org/0000-0003-1114-2250)
- Mattia Mercurio (ORCID: https://orcid.org/0009-0006-7727-1396)
- Stefano Paleari (ORCID: https://orcid.org/0000-0001-6099-560X)
- Giovanni Battista Perego
- Michele Tomaselli
Institutions
- University of Bergamo (IT)
- Medical University of South Carolina (US)
- Erasmus Hospital (BE)
- Ospedale Papa Giovanni XXIII (IT)
- Duke Medical Center (US)
- IRCCS Istituto Auxologico Italiano (IT)
- Duke Clinical Research Institute (US)
- University of Milano-Bicocca (IT)
Publication Details
- Journal
- JACC Advances
- Published
- 2026-11-07
- DOI
- https://doi.org/10.1016/j.jacadv.2026.103424
- Primary Topic
- Cardiac Valve Diseases and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Ministero della Salute
- Ministero dell'Istruzione e del Merito