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Review
. 2024 Jul 9;84(2):195-212.
doi: 10.1016/j.jacc.2024.04.047.

Tricuspid Regurgitation in Patients With Heart Failure and Preserved Ejection Fraction: JACC State-of-the-Art Review

Rebecca T Hahn  1 , JoAnn Lindenfeld  2 , Michael Böhm  3 , Frank Edelmann  4 , Lars H Lund  5 , Philip Lurz  6 , Marco Metra  7 , Ryan J Tedford  8 , Javed Butler  9 , Barry A Borlaug  10
Affiliations
Free article
Review

Tricuspid Regurgitation in Patients With Heart Failure and Preserved Ejection Fraction: JACC State-of-the-Art Review

Rebecca T Hahn et al. J Am Coll Cardiol. .
Free article

Abstract

Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality. Important risk factors for the development of HFpEF are similar to risk factors for the progression of tricuspid regurgitation (TR), and both conditions frequently coexist and thus is a distinct phenotype or a marker for advanced HF. Many patients with severe, symptomatic atrial secondary TR have been enrolled in current transcatheter device trials, and may represent patients at an advanced stage of HFpEF. Management of HFpEF thus may affect the pathophysiology of TR, and the physiologic changes that occur following transcatheter treatment of TR, may also impact symptoms and outcomes in patients with HFpEF. This review discusses these issues and suggests possible management strategies for these patients.

Keywords: heart failure; preserved ejection fraction; tricuspid regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Böhm was supported by the Deutsche Forschungsgemeinschaft (SFB TTR 219, S-01). Dr Lund was supported by Karolinska Institutet, the Swedish Research Council (grant 523-2014-2336), the Swedish Heart Lung Foundation (grants 20150557, 20190310), and the Stockholm County Council (grants 20170112, 20190525). Dr Borlaug was supported by the National Institutes of Health (R01 HL128526, R01 HL162828, and U01 HL160226) and the U.S. Department of Defense (W81XWH2210245). Dr Hahn has received speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic Philips Healthcare, and Siemens Healthineers. Dr Lindenfield has received consulting fees from Abbott Structural, Abiomed, AstraZeneca, Alleviant, Axon, Bayer, Boston Scientific, CVRx, Edwards Lifesciences, Merck, Medtronic, VWave, Vascular Dynamics, and Whiteswell. Dr Böhm has received support from AstraZeneca, Bayer, Boehringer Ingelheim, Medtronic, Novartis, ReCor, Servier, and Vifor. Dr Lund has received grants and honoraria from and served as a consultant for Alleviant, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Edwards, Merck/MSD, Novartis, Novo Nordisk, Owkin, Pharmacosmos, and Vifor Pharma; and has stock ownership in AnaCardio. Dr Lurz has received institutional fees and research grants from Abbott Vascular, Edwards Lifesciences, and ReCor; has received honoraria from Edwards Lifesciences, Abbott Medical, Innoventric, ReCor, and Boehringer Ingelheim; and has stock options with Innoventric. Dr Metra has received consulting honoraria from Abbott Structural, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards Lifesciences, and Roche Diagnostics in the last 3 years. Dr Tedford is the co-chair of the Pulmonary Hypertension due to left heart disease task force for 7th World Symposium on Pulmonary Hypertension; is the Deputy Editor for The Journal of Heart and Lung Transplantation; has served as a consultant for Abbott, Acorai, Aria CV Inc, Acceleron/Merck, Alleviant, Boston Scientific, Cytokinetics, Edwards Lifesciences, Gradient, Lexicon Pharmaceuticals, Medtronic, and United Therapeutics; has served on the steering committee for Merck, Edwards, and Abbott; has served on the research advisory board for Abiomed; and has completed hemodynamic core lab work for Merck. Dr Butler has served as a consultant for Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardiocell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Regeneron, Renibus, Roche, Salamandra, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. Dr Borlaug has received research grant funding from AstraZeneca, Axon, GlaxoSmithKline, Medtronic, Mesoblast, Novo Nordisk, and Tenax Therapeutics; has served on the advisory board, on the steering committee, or as a consultant for Actelion, Amgen, Aria, Axon, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Eli Lilly, Janssen, Merck, Novo Nordisk, and Tenax; and is named inventor (U.S. Patent No. 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure. Dr Edelmann has reported that he has no relationships relevant to the contents of this paper to disclose.

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