Liver-related outcomes in patients with tricuspid regurgitation

The natural history of hepatic involvement in tricuspid regurgitation (TR) remains undercharacterized. We aimed to assess the incidence and risk of liver-related outcomes associated with TR severity and to identify the predictors and survival impact of cirrhosis in patients with ≥moderate TR.

From 2004 to 2022, adults with documented TR severity were retrospectively included. Liver-related outcomes including cirrhosis, hepatocellular carcinoma (HCC), and liver-related death were followed longitudinally.

Among 41 950 patients without prevalent liver disease, 7226 (17.3%) had ≥moderate TR. The median follow-up was 6.4 years. Incidence rates of cirrhosis, HCC and liver-related death in patients with ≥moderate TR were 4.54 [95% confidence interval (CI), 3.89-5.29], 1.25 (95% CI, 0.92-1.68), and 1.33 (95% CI, 0.99-1.77) per 1000 person-years, respectively. Compared with no/trace TR, both moderate and severe TR were associated with an increased risk of cirrhosis, while risks of HCC and liver-related death did not differ statistically across TR severity groups. Among patients with ≥moderate TR, independent predictors of cirrhosis were heart failure with preserved ejection fraction, right ventricular dysfunction, and cholestatic liver injury. Ventricular TR [hazard ratio (HR): 2.33, 95% CI, 1.22-4.43, P = .009] and lead-associated TR (HR: 2.66, 95% CI, 1.16-6.09, P = .02) were associated with a higher risk of cirrhosis than atrial TR. Incident cirrhosis increased all-cause and cardiovascular death risks in patients with ≥moderate TR.

Significant TR is associated with incident cirrhosis, with risk varying by aetiology. The development of cirrhosis portends a worse survival, supporting more comprehensive hepatic evaluation during TR management.