Key result
Exercise-induced tricuspid regurgitation develops in ~34% of patients, strongly linked to baseline TR and AF.
Observational (n=132)
Exercise-induced tricuspid regurgitation occurs in one-third of patients undergoing exercise hemodynamic evaluation and identifies a HFpEF-like phenotype with maladaptive exercise response.
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Exercise-induced tricuspid regurgitation may identify maladaptive heart failure phenotypes; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Exercise-induced preload/afterload changes could affect tricuspid regurgitation (TR). OBJECTIVES: The study aims to assess exercise-induced TR (exTR+), its consequences, and predictors. METHODS: Consecutive patients underwent exercise cardiac catheterization and three-dimensional echocardiography. ExTR+ was defined as a ≥1 grade increase in TR severity. RESULTS: ExTR+ occurred in 34% of 132 patients. Patients with exTR+ were older, had more atrial fibrillation, higher natriuretic peptides/heart failure with preserved ejection fraction probability scores, higher filling pressures, and lower cardiac output (P < 0.05). ExTR+ displayed greater right ventricular dilation, right atrial pressure rise, lower cardiac output, and lower oxygen consumption (P < 0.05). Exercise rather than resting TR regurgitant volume was more associated with cardiac output and oxygen consumption. Baseline TR, atrial fibrillation, and N-terminal pro-brain natriuretic peptide (OR: 1.065, 4.97, and 1.0004 per pg/mL, respectively, P < 0.05) predicted exTR+ (area under the curve: 0.91). CONCLUSIONS: ExTR+ is frequent, identifies heart failure with preserved ejection fraction-like phenotypes with a maladaptive exercise response, and adds information beyond resting TR.
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Baratto et al. (2026) conducted an observational in Exercise-induced tricuspid regurgitation (n=132). Exercise-induced tricuspid regurgitation (≥1 grade increase in TR severity) vs. No exercise-induced tricuspid regurgitation was evaluated on Occurrence of exercise-induced tricuspid regurgitation (≥1 grade increase in TR severity) (p=<0.05). Exercise-induced tricuspid regurgitation occurred in 34% of patients, predicted by baseline TR, atrial fibrillation (OR 4.97), and NT-proBNP (AUC 0.91; P<0.05).
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