Moderate to severe tricuspid regurgitation (TR) is sometimes seen in patients with
heart failure (HF). The frequency has been reported as 20–40% in HF with reduced ejection
fraction (HFrEF) and 30–50% in HF with preserved ejection fraction (HFpEF). The frequency
of severe TR was not high (about 5–12%) in HFrEF, which may be because right ventricular
enlargement is usually limited by the dilated left ventricle in HFrEF. The existence
of moderate to severe TR has been reported to relate to poor prognosis in patients
with HF, which may be associated with renal and hepatic dysfunction derived from venous
congestion. On the other hand, among patients with moderate to severe functional TR,
left heart failure is a cause of TR in 12–17% of the patients. Annular dilatation
accompanying the dilatation of basal portion of the right ventricle is a mechanism
in idiopathic TR with atrial fibrillation, but tricuspid tethering accompanying the
dilatation of mid portion of the right ventricle is seen in patients with left heart
failure and/or pulmonary hypertension. As it has been reported that right ventricular
function rather than left ventricle is important as a prognostic predictor of heart
failure, more attentions may be paid on structural and functional changes in the tricuspid
valve in patients with heart failure.
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