Secondary tricuspid regurgitation (STR) is common in heart failure (HF) and is associated with adverse outcomes. In a retrospective study published in Cardiology, the prognostic value of stratifying patients by right ventricular systolic function was evaluated in severe STR.

The analysis included 106 hospitalized HF patients with severe STR who underwent transthoracic echocardiography after clinical stabilization. Patients were categorized according to RVFAC into a preserved RVFAC group (≥35%; n = 75) and a reduced RVFAC group (<35%; n = 31). Cardiac-related events were assessed over a follow-up period of up to 60 months.

Patients with reduced RVFAC experienced significantly worse outcomes than those with preserved RVFAC. Event-free survival differed markedly between groups (log-rank p = 0.0016). In the preserved RVFAC group, independent predictors of cardiac events included older age, prior HF hospitalization, lower TAPSE, higher right ventricular sphericity index, and greater tricuspid tenting height. In the reduced RVFAC group, TAPSE was the only parameter independently associated with prognosis.

Receiver operating characteristic analyses identified TAPSE thresholds of ≤13.1 mm in the preserved RVFAC group (area under the curve [AUC] 0.897) and ≤13.9 mm in the reduced RVFAC group (AUC 0.907) for predicting cardiac events.

These findings show that RVFAC effectively stratifies prognosis in severe STR. TAPSE and right ventricular morphological parameters further refine risk assessment in HF.