Mutlak D, et al. - Acute heart failure (HF) patients were examined to find out if tricuspid regurgitation (TR) itself is responsible for poor outcome in these subjects or if TR is a surrogate marker of advanced left-sided myocardial or valvular heart disease. It is already known that significant TR is common in HF and portends poor prognosis. In this study, researchers detected multiple coexisting cardiac abnormalities among patients presenting with symptomatic HF and significant TR. Notably, in the presence of normal or mildly elevated pulmonary pressures, TR afforded no additive risk, however, it was found to be related to excess rehospitalizations and mortality in patients with pulmonary hypertension.

Methods

• In a total of 639 patients admitted for acute HF, researchers assessed the link between TR severity and the endpoint of readmission for HF or mortality after adjustment for multiple clinical and echocardiographic parameters.

Results

• Findings demonstrated association of higher TR grade with higher congestion score and with other cardiac abnormalities including reduced left ventricular systolic function, moderate or severe mitral regurgitation, pulmonary hypertension (PH, defined as pulmonary artery systolic pressure ≥ 50 mmHg), and right ventricular dysfunction (all P < 0.001).
• Absence of other cardiac lesions was reported in only 7% of patients with moderate or severe TR.
• No association of moderate or severe TR with readmission for HF or mortality was evident in adjusted models [hazard ratio (HR) 1.24, 95% confidence interval (95% CI) 0.97–1.57].
• Researchers observed that patients with moderate/severe TR had similar risk for HF readmission or death compared with patients with trivial/mild TR when PH was not present (HR 1.17; 95% CI 0.78–1.75, P=0.40) whereas the risk was higher in moderate/severe TR and PH (HR 1.78; 95% CI 1.34–2.36, P < 0.0001).