Structural and Functional Changes in Tricuspid Valve in Patients With Heart Failure

      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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