Dynamic Trends of Secondary Tricuspid Regurgitation in Acute Heart Failure and Association With Outcomes

In acute heart failure (HF), the response of secondary tricuspid regurgitation (STR) to therapeutic management may indicate reverse right ventricular remodeling and response to treatment. This study sought to explore the dynamic trends of STR during acute HF hospitalization and their association with outcomes at follow-up. Among 463 acute hospitalized HF patients, 285 had significant STR on admission and were considered for this analysis. All patients underwent echocardiographic assessment on admission and prior to discharge and were divided into 2 groups: (1) significant STR on admission that improved at discharge (improved STR), and (2) significant STR on admission without improvement at discharge (nonimproved STR). The two groups were propensity matched (1:1) for age, gender, chronic HF, chronic atrial fibrillation, chronic kidney disease, and followed for the primary endpoint of all-cause mortality and HF rehospitalization. A total of 192 matched patients were included: 96 with improved STR and 96 with nonimproved STR. Better right ventricular free wall longitudinal strain and higher NT-pro-BNP on admission were independent predictors for STR improvement. After a median follow-up of 6 months (interquartile range 2.3 to 9.8), 90 (46.9%) patients reached the primary endpoint. Patients with nonimproved STR had significantly worse event-free survival rate (37.5%), compared to the improved STR (68.8%). Nonimproved STR was independently associated with the primary endpoint (adjusted hazard ratio 3.51 [95% confidence interval, 2.04 to 6.04]; p < 0.001). Nonimproved STR provided incremental information over a baseline clinical and echocardiographic model and the presence of nonimproved inferior vena cava without respiratory variation, nonimproved left ventricular filling pressures, and nonimproved NT-pro-BNP for association with the primary endpoint. The dynamic trends of STR carry a clinically relevant value in acute HF. Absence of STR improvement during hospitalization indicates poor event-free survival, outperforming conventional markers of response to HF management.