Introduction & Purpose: Tricuspid regurgitation (TR) is common in patients hospitalized with acute heart failure (AHF). Data on dynamics of TR severity and their prognostic impact are scarce. We investigated the in-hospital evolution of TR in patients with AHF and determined its prognostic relevance.

Methods & Results: The AHF registry prospectively enrolled consecutive patients hospitalized with AHF at the University Hospital Würzburg. Patients discharged alive from hospital with 2 in-hospital routine echocardiograms were eligible for the current analysis. TR severity was graded according to current guidelines as absent or mild, moderate, or severe. The present analysis was based on clinical routine data extracted from electronic records via the Data Warehouse of the University Hospital Würzburg. The primary endpoint was all-cause death or cardiovascular (CV) rehospitalization occurring within 12 months after discharge. 

Among 1000 participants of the AHF-Registry, 447 patients (62% men, mean age 73±12 years, 49% HFpEF) qualified for the current analysis. Echocardiograms were performed 2 days (median; quartiles 1, 4) after admission and 1 day (1, 2) prior to discharge with a median of 8 days (6, 12) between scans. On admission, there were 274 (61%) patients with absent or mild, 109 (24%) with moderate, and 64 (14%) with severe TR; the frequencies prior to discharge were 69%, 25%, and 7%, respectively (p<0.001). In patients with absent or mild TR at admission, TR severity remained unchanged during hospitalization in 243 (89%) patients, while 31 (11%) developed moderate TR. In patients with moderate or severe TR at admission, TR severity improved in 64 (37%) patients to mild TR prior to discharge, while 109 (63%) patients exhibited still moderate (n=80) or severe (n=29) TR. Overall, 199 (45%) patients experienced the combined endpoint within 12 months (21% death, 79% CV hospitalisation). Presence of moderate or severe TR at discharge was associated with an increased risk for the combined endpoint: hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.56–2.85 for moderate TR; HR 2.45, 95%CI 1.47–4.03 for severe TR. These associations were maintained after adjustment for age, sex, left ventricular ejection fraction, and NYHA functional class (HR 2.27, 95% CI 1.64–3.13, p<0.001 for moderate TR; HR 2.62, 95% CI 1.50–4.61, p<0.001 for severe TR). 

Conclusion: In this well characterized cohort of patients hospitalized with AHF, we found a high prevalence of moderate and severe TR both at admission and discharge. More than mild TR prior to discharge was associated with adverse prognosis regarding the subsequent 12 months, suggesting that AHF patients leaving the hospital with relevant TR despite decongestive efforts carry an increased risk. Our results highlight the need for detailed phenotyping of TR in patients with AHF according to morphologic and etiologic aspects to improve early risk stratification and patient selection for appropriate interventions.