One-year follow-up of patients with severe tricuspid regurgitation: prognostic impact of right heart failure staging

INTRODUCTION: Severe tricuspid regurgitation (STR) is associated with adverse outcomes. This nationwide registry describes the prevalence, aetiology, clinical, and echocardiographic profile of STR using contemporary classifications, and evaluates the prognostic impact of a modified right heart failure staging (RHFS). METHODS: We prospectively enrolled consecutive patients with STR from 48 centres over 6 months and followed them for 1 year. TR severity (severe, massive, torrential) and aetiology were defined using current recommendations. A modified RHFS incorporating RV remodelling and systolic dysfunction was applied. RESULTS: We included 1247 patients (mean age 76.7 ± 10.5 years; 70.2% women): 64.9% had severe TR, 24.1% massive TR, and 11.0% torrential TR. V-STR due to left-heart disease was the most frequent aetiology (49.9%), followed by A-STR (19.8%). During follow-up, HF hospitalization occurred in 20.8%, cardiovascular death in 9.2%, and 12.3% underwent tricuspid intervention. In multivariable analysis, Stages III-IV of the modified RHFS were independently associated with HF hospitalization (HR 1.58; 95% CI 1.13-2.23; P = .008) and cardiovascular mortality (HR 2.01; 95% CI 1.27-3.18; P = .003). Massive (HR 1.72; 95% CI 1.02-2.91; P = .041) and torrential TR (HR 2.57; 95% CI 1.24-5.34; P = .011) were also associated with cardiovascular mortality. CONCLUSION: Massive and torrential TR identify patients at the highest risk. The modified RHFS stratifies patients with STR into prognostic categories and may help guide the timing of intervention.