Epidemiology, pathophysiology, diagnosis and management of chronic right‐sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

Abstract

Right‐sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right‐sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate etiology and pathophysiological mechanisms leading to right‐sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options.The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right‐sided heart failure providing practical suggestions for patient identification and management.This article is protected by copyright. All rights reserved.

Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction

“…The HERACLES-HFpEF trial followed a prospective, single-arm, non-randomized design and was conducted at the Heart Center Leipzig at University of Leipzig (ClinicalTrials.gov: NCT04782908). Patients undergoing T-TEER for severe functional TR, 10 with signs and symptoms of HF, a LV ejection fraction (LVEF) ≥50% and invasive evidence of increased LV end-diastolic filling pressures (pulmonary capillary wedge pressure [PCWP] or LVEDP ≥15 mmHg) were included in the present study after written informed consent. Exclusion criteria were (i) the presence of relevant mitral valve regurgitation with need for concomitant interventional treatment, (ii) ≥ moderate aortic stenosis, (iii) pregnancy, (iv) contraindication to perform cardiac magnetic resonance (CMR) imaging (e.g.…”

December 2023 at a glance: Focus on medical therapy in chronic and acute heart failure

“…Right-sided HF and tricuspid regurgitation (TR) are common and strongly associated with poor quality of life and prognosis. [26][27][28] Russo et al 29 assessed characteristics and outcomes of patients with atrial versus ventricular secondary TR (STR) undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) from the TriValve registry. Overall, 298 patients were included in the study, of whom 22% presented atrial STR and 78% ventricular STR.…”