Prognostic Value of Tricuspid Regurgitation in Pulmonary Hypertension and Among the Different WHO Groups (JIMG August 2026)-Article: Prognostic Value of Tricuspid Regurgitation in Pulmonary Hypertension and Among the Different WHO Groups

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This retrospective Mayo Clinic study examined whether secondary tricuspid regurgitation (STR) predicts mortality in pulmonary hypertension (PH) independent of right ventricular (RV) dysfunction. Researchers identified 1,318 adults with PH (RV systolic pressure ≥50 mm Hg) who also had RV free wall longitudinal strain measured. Patients with primary tricuspid disease, reduced left ventricular ejection fraction, significant left-sided valve disease, congenital heart disease, advanced cirrhosis, malignancy, or dialysis were excluded. PH was classified into WHO groups 1, 2, 3, 4, or mixed.<br /><br />Nearly 29% had moderate or greater STR. These patients were older, more symptomatic, more congested, and had worse RV function and higher pulmonary pressures than those with less TR. Over a median follow-up of 1.5 years, 454 patients died.<br /><br />Moderate or severe STR was associated with higher all-cause mortality in unadjusted analysis and remained an independent predictor after adjustment for age, sex, comorbidities, PH group, diuretic use, RV free wall strain, RV fractional area change, tricuspid annular plane systolic excursion, and RV–pulmonary artery coupling. The association held across all WHO PH groups and was present regardless of whether PH was recent or chronic. It also persisted in patients with both preserved and moderately/severely impaired RV strain.<br /><br />The authors conclude that moderate or severe STR carries prognostic significance in PH beyond RV dysfunction alone. They suggest that careful assessment of TR severity is important in PH and that STR may represent a future therapeutic target, though prospective studies are needed to determine whether intervening on TR improves outcomes.

Meta Tag

Concept Secondary Tricuspid Regurgitation

Concept Pulmonary Hypertension

Concept All-Cause Mortality

Concept Right Ventricular Dysfunction

Concept Right VentricularPulmonary Artery Coupling

Keywords

secondary tricuspid regurgitation

pulmonary hypertension

mortality prediction

right ventricular dysfunction

RV free wall strain

WHO PH groups

tricuspid valve disease

prognostic significance

all-cause mortality

retrospective Mayo Clinic study

Secondary Tricuspid Regurgitation

Pulmonary Hypertension

All-Cause Mortality

Right Ventricular Dysfunction

Right VentricularPulmonary Artery Coupling