Does moderate to severe tricuspid regurgitation increase the risk of composite heart failure hospitalization or death in patients with exercise HFpEF?
In patients with exercise HFpEF, the presence of moderate to severe tricuspid regurgitation is associated with worse cardiac reserve and a significantly higher risk of 5-year heart failure hospitalization or death.
BACKGROUND: The clinical significance of at least moderate tricuspid regurgitation (TR) during evaluation for unexplained dyspnea is unclear. This study describes the characteristics, exercise hemodynamics, and 5-year outcomes among patients with moderate to severe TR found to have exercise heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: We included 258 consecutive patients undergoing exercise right heart catheterization for unexplained dyspnea at 2 academic centers in the United States and Italy from April 2017 to October 2024 if they met exercise criteria for HFpEF (peak pulmonary artery wedge pressure PAWP of ≥25 or PAWP-cardiac output CO slope of ≥2). We dichotomized patients by degree of TR (absent or mild vs moderate to severe) during resting echocardiography. We compared hemodynamics by regression analyses and 5-year composite HF hospitalization or death by Cox regression analyses, adjusting for age, sex, and country. There were 206 patients (80%) who met the exercise criteria for HFpEF; 41 (20%) had moderate to severe TR and 165 (80%) had absent or mild TR. Those with worse TR were older (75 years IQR 68-79 years vs 70 years IQR 62-76 years) and had higher resting mean pulmonary artery pressure and PAWP, but a lower CO; after adjustment, worse TR was associated with lower maximum CO (6.6 L/min IQR 5.1-8.1 L/min vs 8.4 L/min IQR 7.0-11.0 L/min, P < 0.001) and higher mean pulmonary artery pressure-CO slope (5.7 IQR 3.6-9.0 vs 4.0 IQR 2.4-5.9, P = 0.022) despite similar exercise time. The worse TR group had higher 5-year composite events (29% vs 11%) (adjusted hazard ratio 3.33, 95% confidence interval 1.46-7.57, P = 0.004). CONCLUSIONS: In patients with exercise HFpEF, the presence of moderate to severe TR was associated with worse cardiac reserve and worse 5-year composite heart failure hospitalization or death.
Dorsey et al. (Sat,) studied this question.
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