Prognostic Determinants in Patients with Secondary Tricuspid Regurgitation Classified by Right Ventricular Systolic Function

INTRODUCTION: Secondary tricuspid regurgitation (STR) is increasingly prevalent in heart failure (HF) patients and independently predicts adverse outcomes. This retrospective study aimed to stratify severe STR patients based on right ventricular fractional area change (RVFAC) and elucidate echocardiographic parameters influencing prognosis. METHOD: Overall, 106 hospitalized HF patients with severe STR were analysed post-stabilization using transthoracic echocardiography. Patients were categorized into preserved RVFAC (≥35%, n = 75) and reduced RVFAC (<35%, n = 31) groups. Long-term outcomes were assessed over 60 months for cardiac-related events. RESULTS: Among 106 patients, those with reduced RVFAC had significantly worse outcomes than those with preserved RVFAC (log-rank test, p = 0.0016). In the preserved RVFAC group, independent predictors of cardiac events included age, prior HF hospitalization, lower TAPSE, higher RV sphericity index, and greater tricuspid tenting height. In the reduced RVFAC group, only TAPSE remained a significant prognostic factor. ROC analyses identified TAPSE ≤13.1 mm (AUC 0.897) and ≤13.9 mm (AUC 0.907) as optimal cutoffs for predicting cardiac events in preserved and reduced RVFAC groups, respectively. CONCLUSION: RVFAC serves as an effective prognostic marker in severe STR patients, with additional assessment of TAPSE and morphological parameters enhancing risk stratification. These findings underscore the importance of comprehensive right heart evaluation in managing STR-associated HF, facilitating tailored therapeutic strategies, and improving patient outcomes.