JACC Cardiovasc Imaging. 2026 Jun 10:S1936-878X(26)00260-3. doi: 10.1016/j.jcmg.2026.04.016. Online ahead of print.
ABSTRACT
BACKGROUND: Secondary tricuspid regurgitation (STR) is frequently observed in patients with pulmonary hypertension (PH). Whether it independently confers mortality risk beyond the associated right ventricular (RV) dysfunction remains unknown.
OBJECTIVES: The aim of this study was to evaluate the prognostic significance of STR in patients with PH other than related to left-sided valve disease or reduced ejection fraction and across the individual World Health Organization (WHO) groups of PH.
METHODS: Patients with RV systolic pressures ≥50 mm Hg on echocardiography between 2010 and 2023 and measured RV free wall longitudinal strain were identified retrospectively. Primary tricuspid valve disease, reduced left ventricular ejection fraction, significant left-sided valve disease, congenital heart disease, decompensated cirrhosis, malignancy, and dialysis were exclusion criteria. PH was classified according to the WHO group classification. Patients were followed for all-cause mortality.
RESULTS: Of 1,318 patients (mean age 67 years, 61% women, 29% with moderate or greater STR, median RV free wall longitudinal strain 19%), WHO groups 1, 2, 3, and 4 PH were present in 33%, 11%, 32%, and 12%, respectively. Patients with moderate or greater STR were more symptomatic and congested and had worse RV function and pulmonary pressures. Over a median 1.5 years (Q1-Q3: 0.3-4.6 years), 454 patients died. Moderate or severe STR was associated with mortality independent of various RV function measures or RV-pulmonary arterial coupling. This remained true across the individual WHO groups of PH.
CONCLUSIONS: Moderate or severe STR conferred mortality risk in patients with PH without left-sided valve disease or reduced left ventricular ejection fraction, beyond what can be explained by the associated RV dysfunction or impaired RV-pulmonary arterial coupling. Whether STR may represent an additional therapeutic target in certain subgroups with PH requires future investigation.
PMID:42268173 | DOI:10.1016/j.jcmg.2026.04.016