title: Presence of ´isolated´ tricuspid regurgitation should prompt the suspicion of heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Diastolic dysfunction of the left ventricle is common but frequently under-diagnosed. Particularly in advanced stages affected patients may present with significant functional tricuspid regurgitation (TR) as the most prominent sign on echocardiography. The underlying left ventricular pathology may eventually be missed and symptoms of heart failure are attributed to TR, with respective therapeutic consequences. The aim of the present study was to determine prevalence and mechanisms underlying TR evolution in heart failure with preserved ejection fraction (HFpEF).
  
  
  RESULTS
  Consecutive HFpEF patients were enrolled in this prospective, observational study. Confirmatory diagnostic tests including echocardiography and invasive hemodynamic assessments were performed. Of the 175 patients registered between 2010 and 2014, 51% had significant (moderate or severe) TR without structural abnormalities of the tricuspid valve. Significant hemodynamic differences between patients with and without relevant TR were encountered. These included elevated pulmonary vascular resistance (p = 0.038), reduced pulmonary arterial compliance (PAC, p = 0.005), and elevated left ventricular filling pressures (p = 0.039) in the TR group. Multivariable binary logistic regression analysis revealed diastolic pulmonary artery pressure (p = 0.029) and PAC (p = 0.048) as independent determinants of TR. Patients were followed for 18.1±14.1 months, during which 32% had a cardiac event. While TR was associated with outcome in the univariable analysis, it failed to predict event-free survival in the multivariable model.
  
  
  CONCLUSIONS
  The presence of ´isolated´ functional TR should prompt the suspicion of HFpEF. Our data show that significant TR is a marker of advanced HFpEF but neither an isolated entity nor independently associated with event-free survival.
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Kammerlander
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Caroline
authors.initials: C
authors.lastname: Zotter-Tufaro
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Aschauer
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Duca
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dalos
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Winkler
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
authors.affiliation: From the Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010446:Peptide Fragments / Q000032:analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D013318:Stroke Volume; D015996:Survival Rate; D014261:Tricuspid Valve / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000401:mortality
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain