Abstract
BACKGROUND: Tricuspid regurgitation (TR) is a common finding in heart failure (HF) and is associated with adverse outcomes. Data about sex differences in TR prevalence, aetiology and prognosis among patients with HF and their subgroups are still scarce. METHODS: Patients with HF with a recent transthoracic echocardiography were enrolled in our registry (NCT04570098). Based on a left ventricular ejection fraction (LVEF) cut-off of 50%, patients were divided into those with reduced (rEF) and preserved ejection fraction (pEF). Follow-ups were conducted after 3, 6 and 12 months. Analysis was performed in the overall cohort and after matching for age and comorbidities. RESULTS: Between 2020 and 2022, 1012 patients with HF were prospectively enrolled, including 38% women. pEF was more prevalent among females (60%), whereas rEF was more common among males (60%) (p<0.001). Women presented a higher prevalence of at least moderate TR (42%) compared with men (29%) without significant differences regarding TR aetiology. Severe TR was associated with increased mortality in women with pEF (HR 2.341, 95% CI 1.075 to 5.098, p=0.032) and men with rEF (HR 3.163, 95% CI 1.675 to 5.973, p<0.001), while there was only a non-significant trend in the opposite cohorts. These findings were consistent even after matching. Moreover, severe TR was associated with hospitalisations in both HF cohorts and with cardiovascular hospitalisation in male patients, but not female patients with HF. CONCLUSION: A higher TR prevalence was observed in women compared with men without differences in TR aetiology. Severe TR may predict mortality in female patients with pEF and male patients with rEF, but not vice versa. These results may have an impact on sex-specific follow-up and treatment strategies.