Introduction & Purpose: Community-based data regarding the prevalence of mitral (MR) and tricuspid regurgitation (TR) in patients with acute heart failure (AHF) are scarce. Therefore, we aimed to evaluate the prevalence and determinants of MR and TR in an all-comer population hospitalized with AHF.

Methods & Results: Within the scope of a single-center prospective AHF-Registry, all patients hospitalized with AHF at the Department Internal Medicine I of the University Hospital Würzburg between 2015–2020 were phenotyped (n=1906). MR and TR severity were assessed in routine transthoracic echocardiography using two-dimensional and color Doppler echocardiography and graded according to current guidelines as none/mild/moderate/severe. All data obtained during index hospitalization were abstracted from electronic health records provided by the Data Warehouse of the University Hospital Würzburg.

Among 1542 patients with available reports on echocardiography during index hospitalization, MR/TR quantification was available in 1484 (96%)/1492 (97%) patients, respectively. The echo was performed within a median of 3 days after admission (quartiles 2, 5). Prevalence of no, mild, moderate, and severe MR was 8%, 58%, 20% and 14%, respectively, while the respective severity of TR was 7%, 58%, 22%, and 13%. Combined valve disease of at least moderate MR and moderate TR was present in 181 patients (12%). Patients with severe MR were younger and more often of male sex, while patients with severe TR were of similar age but more often women when compared to patients with the respective mild or moderate valve regurgitation (table). 

Patients with moderate or severe MR had lower left ventricular ejection fraction (LVEF) and higher N-terminal pro-B-type natriuretic peptide (NTproBNP) levels than those with no or mild MR. For the tricuspid valve, only NTproBNP was associated with TR severity, while LVEF was not. 

Conclusion: In a well-characterized cohort of consecutive patients hospitalized with AHF, we found a high prevalence of MR and TR. While the prevalence of severe MR was higher in patients with HF and reduced LVEF, the presence of severe TR was independent of HF phenotype. Further studies are needed to elucidate determinants of potential changes in regurgitation severity and to assess the prognostic impact of MR and TR as well as potential treatment options.