Key result
AF linked to ~5-fold higher odds of exercise-induced tricuspid regurgitation.
Why the study?
Exercise can worsen tricuspid regurgitation, but the occurrence, predictive factors, pathophysiology, and clinical relevance of exercise-induced tricuspid regurgitation remained unclear.
Observational (n=132)
Exercise-induced tricuspid regurgitation occurs in one-third of patients undergoing exercise right heart catheterization and 3D echocardiography, is strongly predicted by resting TR severity, atrial fibrillation, and NT-proBNP, and is associated with maladaptive hemodynamic responses during exercise.
Answers are grounded in this paper and cite their sources.
ExTR may flag maladaptive exercise hemodynamics; hypothesis-generating for risk stratification pending prospective validation.
Background Exercise could worsen tricuspid regurgitation (TR). However, the pathophysiology and clinical relevance of exercise-induced TR (exTR) remain unclear yet. Aims We sought to evaluate the occurrence of exTR, its impact on exercise pathophysiology, and identify predictive factors. Methods Consecutive patients undergoing simultaneous three-dimensional echocardiography and right heart catheterization at rest and during exercise were classified as exercise-induced TR (exTR+) if TR severity increased by ≥1 grade during exercise. Clinical characteristics were compared between exTR+ and exTR-, and logistic regression and marginal effect analyses were used to identify predictors of exTR. Results ExTR occurred in 34% of 132 patients (figure 1). ExTR+ patients were older(79 [73-82] vs 69 [56-78] years), more frequently had atrial fibrillation (AF) (67 vs 17%), higher NTproBNP (1374 [676-3040] vs 326 [124-824] pg/ml), larger left atrium (p=0.001), and higher heart failure with preserved ejection fraction (HFpEF) probability scores (93 [72-95] vs 52 [26-76]%) (p<0.001), (p<0.001). ExTR+ exhibited greater baseline tricuspid regurgitation (TR) severity (p<0.001), larger right ventricle (RV) (p<0.05) and worse resting hemodynamics. ExTR+, as compared with exTR-, displayed worse maladaptive exercise responses, including dynamic RV dilation (p<0.001), marked right atrial pressure (RAP) rise (20±8 vs 13±6 mmHg, p<0.001), lower cardiac output (CO) (6.17 [4.99 ;7.81] vs 8.04 [6.08 ;10.45] L/min, p<0.001) and exercise capacity (p<0.05). Baseline TR (OR 1.065, 95% CI 1.015–1.117, p=0.010), AF (OR 4.97, 95% CI 1.12–22.01, p=0.035), and NTproBNP (OR 1.0004 per pg/ml, 95% CI 1.00004–1.0008, p=0.031) independently predicted exTR, with excellent model discrimination (AUC 0.91). Predicted probabilities showed that AF markedly increased the likelihood of exTR risk across increasing NT-proBNP and resting TR severity (figure 2). Conclusions ExTR may frequently occur in patients with HFpEF-like clinical–hemodynamic phenotype. ExTR is associated with a maladaptive exercise response, highlighting its potential role for risk stratification in patients with borderline TR. Its occurrence is predictable by combining resting TR severity, AF, and NT-proBNP.
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Baratto et al. (2026) conducted an observational in Exercise-induced tricuspid regurgitation (n=132). Exercise-induced tricuspid regurgitation (exTR+, TR severity increase ≥1 grade during exercise) vs. No exercise-induced tricuspid regurgitation (exTR-) was evaluated on Occurrence and predictors of exercise-induced tricuspid regurgitation (exTR, defined as TR severity increase by ≥1 grade during exercise) (OR 4.97, 95% CI 1.12-22.01, p=0.035). Exercise-induced tricuspid regurgitation occurred in 34% of patients, predicted by AF (OR 4.97, p=0.035), baseline TR (OR 1.065), and NT-proBNP (AUC 0.91).
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