Heart failure & cardiomyopathies
Dynamic Tricuspid Regurgitation in Heart Failure with Preserved Ejection Fraction
Authors' conclusion
Tricuspid regurgitation in HFpEF is related to advanced RA myopathy and often worsens during exercise leading to dynamic right-sided heart failure, exaggerated ventricular interaction, impaired CO reserve, and increased risk for adverse outcomes.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF) undergoing invasive haemodynamic exercise testing
- Participants
- 169 patients
- Exposure
- Tricuspid regurgitation (TR) severity: no TR vs mild TR vs ≥ moderate TR
- No TRn = 91reference
- Mild TRn = 44
- ≥ moderate TRn = 34
- Outcome
- Dynamic TR during exercise and its relationships with haemodynamics, cardiopulmonary reserve and prognosis
Methodological detailsinvasive haemodynamic exercise testing with simultaneous echocardiography and expired gas analysis
- Invasive haemodynamic exercise testing with simultaneous echocardiography and expired gas analysis
Main finding
As reported in the abstract
- TR severity frequently worsened during exercise; over half of patients with moderate TR at rest displayed severe TR during exercise
- Greater TR severity: stepwise increases in right atrial (RA) pressure and septal flattening, decreases in cardiac output (CO)
- Exercise pulmonary vascular pressures did not differ across groups
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Event rates by TR during exercise≥ moderate TRvs No TRTR during exercise | 2.85 (1.18–6.85) | |
| 0.10.31310Hazard ratio (log scale) |
Event rates by TR during exercise
- Mild TR had similar prognosis as no TR in adjusted models
Original publication
Dynamic Tricuspid Regurgitation in Heart Failure with Preserved Ejection Fraction. Eur J Heart Fail. Published 22 September 2025. doi:10.
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