Exercise-Induced Tricuspid Regurgitation: Clinical Predictors and Hemodynamic Implications

Exercise-induced preload/afterload changes could affect tricuspid regurgitation (TR).

The study aims to assess exercise-induced TR (exTR+), its consequences, and predictors.

Consecutive patients underwent exercise cardiac catheterization and three-dimensional echocardiography. ExTR+ was defined as a ≥1 grade increase in TR severity.

ExTR+ occurred in 34% of 132 patients. Patients with exTR+ were older, had more atrial fibrillation, higher natriuretic peptides/heart failure with preserved ejection fraction probability scores, higher filling pressures, and lower cardiac output (P < 0.05). ExTR+ displayed greater right ventricular dilation, right atrial pressure rise, lower cardiac output, and lower oxygen consumption (P < 0.05). Exercise rather than resting TR regurgitant volume was more associated with cardiac output and oxygen consumption. Baseline TR, atrial fibrillation, and N-terminal pro-brain natriuretic peptide (OR: 1.065, 4.97, and 1.0004 per pg/mL, respectively, P < 0.05) predicted exTR+ (area under the curve: 0.91).

ExTR+ is frequent, identifies heart failure with preserved ejection fraction-like phenotypes with a maladaptive exercise response, and adds information beyond resting TR.