Many patients with severe, symptomatic tricuspid regurgitation (TR) may also present with advanced heart failure with preserved ejection fraction (HFpEF), and treatments for each condition may impact the other condition. A JACC State-of-the-Art Review on the topic, published on July 1, explores the relationship between these two conditions and proposes management strategies.

Rebecca T. Hahn, MD, FACC, et al., present the overlap in risk factors for TR and HFpEF, such as the four population attributable risk factors that predict progression of TR and that mirror those of HFpEF: pulmonary artery systolic pressure ≥36 mm Hg, left atrial enlargement, age ≥60 years and history of atrial fibrillation (AFib). “The similarities of predictive parameters as well as common clinical presentation have led investigators to presume that HFpEF and TR may indeed be related,” write the authors.

They describe the clinical presentation of TR and HFpEF and how they relate, highlighting how AFib, a strong predictor of developing significant TR, may also be a marker for HFpEF. In addition, they highlight the increasing commonality of biatrial myopathy in HFpEF patients, found to be associated with increased prevalence of significant TR.

Taking into account the guideline-directed management of HFpEF and recommendations for managing TR, the authors propose a management algorithm when caring for patients experiencing both conditions. They suggest that “if a high prevalence of HFpEF does exist in the patient population with severe, symptomatic TR, then the medication use for the [TRILUMINATE Pivotal Trial] highlights a possible area of improvement in the implementation of optimal medical therapy since the trial was completed prior to the addition of SGLT2 recommendations.”

The review also includes a breakdown of indications for and timing of intervention to address TR in the HFpEF patient population and the impact structural TR intervention may have, along with a look at what innovative breakthroughs in cardiovascular disease detection could mean for the future of TR and HFpEF management.

“Earlier diagnosis of both HFpEF and valvular heart disease holds promise for improving outcomes for our patients before progression to irreversible stages,” writes the authors. “Use of machine learning and deep learning may play an important role in earlier diagnosis.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Patient Care, Atrial Fibrillation, Tricuspid Valve Insufficiency, Heart Failure