Key result
Tricuspid regurgitation progression after left-sided valvular intervention occurred in 12.0% of patients at 5 years and was associated with increased all-cause mortality (adjusted HR 2.77).
Why the study?
Tricuspid regurgitation progression following left-sided valvular heart disease correction is a critical clinical concern with uncertain incidence, predictors, and outcomes in contemporary cohorts.
Cohort (n=1,644)
Tricuspid regurgitation progression occurs in 12% of patients at 5 years after left-sided valve intervention and is strongly associated with increased mortality and heart failure hospitalization.
TR progression after left-sided valve intervention identifies higher-risk patients; leaves open whether targeted TR intervention improves outcomes.
BACKGROUND: Tricuspid regurgitation (TR) progression following left-sided valvular heart disease (VHD) correction is a critical clinical concern. This study aimed to determine the incidence, predictors and outcomes of TR progression in a contemporary cohort. METHODS: We analysed 1644 patients (mean age 73 years, 62% men) without severe TR who underwent surgical or transcatheter treatment for aortic or mitral disease between 2014 and 2018. TR progression was defined as an increase in TR grade to moderate or severe on follow-up echocardiography. RESULTS: At 5 years, TR progression incidence was 12.0% (95% CI 10.5% to 13.7%). Baseline factors associated with TR progression included older age, female sex, atrial fibrillation, prior pacemaker implantation and larger tricuspid annular diameter (TAD). The relationship between TAD and TR progression was linear (HR 1.08; 95% CI 1.04 to 1.11; p<0.001), with sex differences mitigated by indexing TAD to body surface area. TR progression was associated with increased all-cause mortality (adjusted HR 2.77; 95% CI 2.16 to 3.56; p<0.001) and a combined endpoint of death or heart failure hospitalisation (adjusted HR 2.91; 95% CI 2.21 to 3.82; p<0.001). CONCLUSIONS: TR progression is common after left-sided VHD correction and is associated with adverse outcomes. Indexing TAD to body surface area mitigates sex differences in risk assessment. These findings suggest that lower thresholds for prophylactic tricuspid intervention may be warranted in high-risk patients.
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Wang et al. (2025) conducted a cohort in Left-sided valvular heart disease (n=1,644). Surgical or transcatheter treatment for aortic or mitral disease was evaluated on Tricuspid regurgitation (TR) progression (increase in TR grade to moderate or severe) (95% CI 10.5 to 13.7). Tricuspid regurgitation progression after left-sided valvular intervention occurred in 12.0% of patients at 5 years and was associated with increased all-cause mortality (adjusted HR 2.77).
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