Management of Patient With Tricuspid Regurgitation and Heart Failure With Preserved Ejection Fraction

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and tricuspid regurgitation are increasingly recognized as interrelated conditions with overlapping management approaches. CASE SUMMARY: A 69-year-old woman presented with worsening palpitations and exertional dyspnea. Her symptoms, in combination with a preserved ejection fraction and evidence of increased left ventricular filling pressures, were indicative of HFpEF. Echocardiographic examination revealed torrential tricuspid regurgitation. Guideline-directed medical therapy was optimized, resulting in improvement of tricuspid regurgitation severity. DISCUSSION: Recent guidelines for HFpEF management emphasize the use of diuretics for symptom control and the addition of sodium-glucose cotransporter 2 inhibitors and sacubitril-valsartan to improve outcomes. The case underscores the importance of addressing the underlying hemodynamic contributors to tricuspid regurgitation before considering surgical or catheter-based interventions. TAKE-HOME MESSAGES: Guideline-directed medical therapy for HFpEF plays a crucial role in symptom relief, improves outcomes, and may help reduce tricuspid regurgitation severity.