Prevalence, in-hospital course and prognostic value of tricuspid regurgitation in an all-comer population hospitalized for acute heart failure
Authors: Schramm S , Albert J , Chen M , Sahiti F , Cejka V , Fette G , Ertl G , Angermann C E , Frantz S , Gueder G , Stoerk S , Morbach C 
Published: January 2025

Background

There are emerging interventional treatment options targeting tricuspid regurgitation (TR) in patients with heart failure. Nevertheless, community-based data regarding tricuspid regurgitation (TR) in patients with acute heart failure (AHF) are scarce.

Purpose

To determine prevalence, in-hospital course and prognostic value of TR in an all-comer collective of patients hospitalized for AHF.

Methods

In a university tertiary care center, patients hospitalized for AHF between 2015 and 2020 were included in a prospective AHF registry (n= 1000). We abstracted clinical data and routine transthoracic echocardiography (TTE) results from electronic health records. In patients with more than mild TR, the TTE images were reviewed by an expert sonographer to confirm TR severity according to current guidelines. Patients with TTE entered the current analysis regarding prevalence of TR, a subset of patients receiving serial echocardiography entered the analyses regarding in-hospital course and prognosis of TR severity. We identified potential predictors of severe TR at discharge using binary logistic regression and assessed prognosis using Cox regression adjusted for age and sex.

Results

Out of n= 934 AHF patients, n= 318 (34%) patients (75 ± 12 years, 44% female) had moderate/severe (m/s) TR at admission. N= 452 patients underwent serial TTE of whom n= 165 (37%) had m/sTR at admission; in n=108 (65%) patients TR remained m/s while TR improved in n= 57 (35%) patients. Patients with persistent m/s TR at discharge had a higher prevalence of peripheral oedema on admission and discharge when compared to those with improved TR (table). Further, patients with improved TR showed a significant reduction in systolic pulmonary artery pressure while sPAP remained unchanged in the group with persistent moderate/severe TR (table). NT-proBNP decreased significantly between admission and discharge in both groups (table). TR at discharge was strongly associated with NT-proBNP (OR= 2.48), E-wave (OR= 3.34) and TR V-max (OR= 4.40). Patients with m/s TR at discharge had a significantly worse prognosis when compared to patients with persistent ≤ mild or improved TR regarding all-cause death or cardiovascular hospitalization (HR 2.15 [95%CI 1.62 – 2.85]) as well as regarding death or rehospitalization for heart failure (HR 2.19 [95%CI 1.59 – 3.03]).

Conclusion

In an all-comer AHF patient population, prevalence of m/s TR was high. TR severity at discharge was strongly associated with parameters of hypervolemia, thus supporting maximal therapeutic efforts towards recompensation in AHF patients. M/s TR at discharge was associated with a significantly worse prognosis when compared to patients with ≤ mild TR. Confirmation of our results as well as the evaluation of a potentially beneficial effect of TR interventions in AHF patients with significant TR despite maximal recompensation might be subject to future research.