Aims Previous studies have demonstrated that moderate/severe tricuspid regurgitation (TR) is associated with adverse outcome in patients with heart failure (HF) with reduced ejection fraction. Little is known about the prevalence and prognostic value of TR in patients of stage B HF and those with stage C HF with preserved ejection fraction (HFpEF). We aimed to investigate the prevalence and prognosis of TR in patients with HFpEF. Methods and results From 2013 to 2017, 2014 patients with stage B (n = 1341) or C (n = 673) HFpEF were enrolled in the study. Detailed transthoracic echocardiogram was performed, and the severity of TR was graded as no, mild, moderate, and severe. The mean age of the study population was 66.7 ± 14.1 years old, and 46% were men. Mean left ventricular ejection fraction was 62.2 ± 5.5%. The prevalence of moderate/severe TR increased from stage B to C HF (8% to 16%, respectively, P < 0.01). Older age, hyperlipidaemia, atrial fibrillation, left ventricular mass, and right ventricular systolic pressure were independently associated with moderate/severe TR (P < 0.05 for all). With a median follow-up of 3.8 (2.9-4.7) years, 346 patients died and 234 developed HF requiring hospitalization. Kaplan-Meier curve revealed that the presence of moderate/severe TR was associated with all-cause mortality, HF requiring hospitalization and cardiovascular death (log-rank test P < 0.01). Multivariable analysis demonstrated that moderate (hazard ratio = 1.5; 95% confidence interval: 1.1-2.2; P < 0.05) and severe TR (hazard ratio = 2.1; 95% confidence interval: 1.3-3.3; P < 0.01) were independently associated with mortality, HF requiring hospitalization and cardiovascular death. Conclusions The presence of moderate/severe TR is not uncommon in patients with stage B HF and stage C HFpEF. Importantly, moderate/severe TR was independently associated with mortality and HF requiring hospitalization.

Background Severe tricuspid regurgitation (TR) is associated with poor outcome, but TR remains poorly understood and under-treated. Purpose To examine the impact of TR at different stages of heart failure. Methods 3275 patients with outpatient echocardiogram done at our Hospital in 2013–15 with a mean follow-up of 1092 days were analyzed retrospectively. TR was graded by a semi-quantitative approach using jet-area on multiple views and inferior vena cava (IVC) flow pattern. Multivariate Cox proportional hazard model assessed for mortality, time-to-first heart failure hospitalization, and major adverse cardiovascular event in 3 years. Results were adjusted for age, sex, left ventricular ejection fraction (LVEF), left atrial enlargement, pre-existing cardiovascular, peripheral vascular and cerebrovascular disease, moderate-to-severe aortic or mitral valve disease, pulmonary hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, malignancy, and heart failure stages (0=no heart failure, A=risk factor present, B=structural abnormality, C=symptomatic D=advanced). Subgroup analysis stratified by heart failure stage 0, stage A/B and stage C/D was done. Kaplan-Meier function, log-rank test, logistic regression, AURUC, and goodness-of-fit test were done. Results In patients with stage A-B heart failure, severe TR had a hazard ratio of 2.93 for death in 3 years compared to no TR (95% CI 1.11–7.73, p=0.03) and moderate TR had a hazard ratio of 2.35 (95% CI 1.28–4.31, P=0.006). In stage C/D, severe TR had a hazard ratio of 2.17 (95% CI 1.12–4.16, p=0.02) and moderate TR had no significant effect (hazard ratio 1.09, p=077). For heart failure hospitalization, severe TR had no significant association in stage A/B but had a hazard ratio of 3.74 in stage C/D (95% CI 1.81–7.7, p<0.001). TR had no impact on major adverse cardiovascular event in this model. No significant interaction was found between TR and heart failure stage, ejection fraction, and valvular heart disease. The model had C-statistics of 0.82 for 3-year mortality, 0.90 for heart failure hospitalization, and 0.81 for MACE, with insignificant Hosmer-Lemeshow goodness-of-fit test p for each, indicating good fit. Conclusion The association between TR and increased mortality in heart failure is apparent early and attenuated later, whereas that of TR and heart failure symptom decompensation appears late. Acknowledgement/Funding None