Incidence, predictors and outcomes of tricuspid regurgitation progression after left-sided valvular intervention

Tricuspid regurgitation (TR) progression following left-sided valvular heart disease (VHD) correction is a critical clinical concern. This study aimed to determine the incidence, predictors and outcomes of TR progression in a contemporary cohort.

We analysed 1644 patients (mean age 73 years, 62% men) without severe TR who underwent surgical or transcatheter treatment for aortic or mitral disease between 2014 and 2018. TR progression was defined as an increase in TR grade to moderate or severe on follow-up echocardiography.

At 5 years, TR progression incidence was 12.0% (95% CI 10.5% to 13.7%). Baseline factors associated with TR progression included older age, female sex, atrial fibrillation, prior pacemaker implantation and larger tricuspid annular diameter (TAD). The relationship between TAD and TR progression was linear (HR 1.08; 95% CI 1.04 to 1.11; p<0.001), with sex differences mitigated by indexing TAD to body surface area. TR progression was associated with increased all-cause mortality (adjusted HR 2.77; 95% CI 2.16 to 3.56; p<0.001) and a combined endpoint of death or heart failure hospitalisation (adjusted HR 2.91; 95% CI 2.21 to 3.82; p<0.001).

TR progression is common after left-sided VHD correction and is associated with adverse outcomes. Indexing TAD to body surface area mitigates sex differences in risk assessment. These findings suggest that lower thresholds for prophylactic tricuspid intervention may be warranted in high-risk patients.