The right heart perspective in chronic cardiorenal syndrome: the key role of right heart function and tricuspid regurgitation innovation

Cardiorenal syndrome (CRS) refers to the pathophysiological interaction between cardiac dysfunction and kidney injury. Traditional CRS research has focused primarily on the impact of left heart failure on renal function. However, increasing evidence suggests that abnormalities in right heart function, particularly tricuspid regurgitation (TR), critically exacerbate the progression of CRS by promoting renal venous congestion, worsening kidney function, and further aggravating right heart failure. With the aging population and prolonged survival of patients with heart failure, the prevalence of TR has significantly increased and has a substantial impact on prognosis. Therefore, there is an urgent need to reassess the role of TR in heart-kidney interactions. This review summarizes the pathophysiology, clinical evidence, and treatment strategies of TR in the context of CRS, with the aim of raising awareness of the right-heart-centered perspective. Kidney injury caused by right heart dysfunction is driven by multiple mechanisms, among which elevated right atrial pressure and consequent renal venous congestion appear to be more important than reduced renal perfusion caused by low cardiac output alone. In patients with moderate or severe TR, renal function deteriorates significantly, whereas interventional treatment that reduces TR can improve right heart function and lower the risk of adverse events. Future research should challenge the traditional left-heart-dominant paradigm, focusing on mechanistic studies, early assessment and risk stratification, interventional therapy, and the synergistic effects of new drug combinations. Addressing current limitations and research gaps is crucial to overcoming therapeutic bottlenecks and improving long-term outcomes in patients with chronic cardiorenal syndrome.