Natural history outcome of moderate tricuspid regurgitation with preserved left-ventricular ejection fraction

Background: The long-term natural history of moderate tricuspid regurgitation (TR) patients with preserved left-ventricular ejection fraction (LVEF) and without severe left-sided valvular heart disease (VHD) remains ambiguous. We aimed to assess the outcomes of patients with moderate TR, preserved LVEF and without concomitant severe left-sided VHD. Methods: We evaluated patients diagnosed with moderate TR in our centers between 2012 and 2020. The primary outcome was all-cause death, the secondary outcome was the composite of all-cause death+heart failure (HF) hospitalization, also accounting for pulmonary artery systolic pressure (PASP) values and concomitant moderate left-sided VHD. Results: Among 1198 moderate TR patients, 53 % had New York Heart Association class ≥II and mean LVEF was 58 ± 5 %. After a median follow-up of 2.9 years, 3-year survival was 69 % (95 % confidence interval [CI]: 66 %-72 %), significantly worse than an age- and gender-matched population (p < 0.001), and 3-year survival free from the secondary composite outcome was 63 % (95 % CI: 60-67 %). At secondary analysis, increasing PASP values were associated with worse adjusted prognosis, and in patients with PASP <35 mmHg 3-year survival free from the primary and secondary outcome was 85 % (95 % CI: 80 %-89 %) and 80 % (95 % CI: 75 %-86 %), respectively. Finally, among patients with concomitant moderate left-sided VHD groups, the group with moderate aortic stenosis+moderate TR presented the worst adjusted prognosis, and patients with isolated moderate TR had a yearly mortality of 8.9 % (95 % CI: 6.0 %-11.0 %). Conclusions: Our cohort of moderate TR patients, despite having preserved LVEF and no concomitant severe left-sided VHD, presented significant risk of death and of HF hospitalization.