Do women fare better in tricuspid regurgitation? Unveiling the gender advantage in tricuspid valve disease

Background Severe tricuspid regurgitation (TR) is more prevalent in women, but it remains unclear whether gender influences clinical outcomes in tricuspid valve disease. This study aimed to investigate: 1) gender-related differences in clinical presentation and right ventricular (RV) remodeling, and 2) the association between gender and all-cause mortality in patients with severe TR. Methods The study enrolled patients with at least severe TR (severe, massive and torrential), assessed by 2D echocardiography, who underwent contemporary cardiac magnetic resonance (CMR) imaging. The primary outcome was all-cause mortality. Results A total of 326 patients with at least severe TR were recruited from five tertiary care hospitals (mean age 71 ± 11 years; 67% female). Women exhibited a lower prevalence of diabetes, coronary artery disease, and kidney disease (p<0.05). Atrial functional TR was more prevalent in women, whereas men more frequently had ventricular TR (p<0.05). Women demonstrated lower index RV and right atrial (RA) volumes and higher right ventricular ejection fraction (RVEF) (p<0.01). There were no differences in the proportion of men and women undergoing tricuspid valve interventions (28% vs. 29%, p=0.53). Women had better 10-year survival rates compared to men (53% vs. 25%, p<0.001). Gender remained associated with all-cause mortality in multivariable analysis and after propensity score matching (hazard ratio for male gender: 2.08 [1.30-3.33], p=0.002). Conclusion Women have a higher prevalence of severe TR; however, TR in women are characterized by fewer comorbidities, predominantly atrial TR, lower indices of RV remodeling, and better long-term survival.