Exercise Capacity and Clinical Outcomes in Chronic Heart Failure Patients with Mild Tricuspid Regurgitation

Kosuke Nakamura; Suguru Ishizaka; Kazunori Omote; Yutaro Yasui; Yoshifumi Mizuguchi; Sakae Takenaka; Yui Shimono; Ko Motoi; Hiroyuki Aoyagi; Yoji Tamaki; Sho Kazui; Yuki Takahashi; Kohei Saiin; Seiichiro Naito; Atsushi Tada; Yuta Kobayashi; Takuma Sato; Kiwamu Kamiya; Toshiyuki Nagai; Toshihisa Anzai

doi:10.3390/jcm12237459

Exercise Capacity and Clinical Outcomes in Chronic Heart Failure Patients with Mild Tricuspid Regurgitation

J Clin Med. 2023 Dec 1;12(23):7459. doi: 10.3390/jcm12237459.

Authors

Kosuke Nakamura¹, Suguru Ishizaka¹, Kazunori Omote¹, Yutaro Yasui¹, Yoshifumi Mizuguchi¹, Sakae Takenaka¹, Yui Shimono¹, Ko Motoi¹, Hiroyuki Aoyagi¹, Yoji Tamaki¹, Sho Kazui¹, Yuki Takahashi¹, Kohei Saiin¹, Seiichiro Naito¹, Atsushi Tada¹, Yuta Kobayashi¹, Takuma Sato¹, Kiwamu Kamiya¹, Toshiyuki Nagai¹, Toshihisa Anzai¹

Affiliation

¹ Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan.

Abstract

Aim: The present study aimed to investigate the impact of mild tricuspid regurgitation (TR) on the exercise capacity or clinical outcomes in patients with chronic heart failure (CHF).

Methods and results: The study enrolled 511 patients with CHF who underwent cardiopulmonary exercise testing (CPET) between 2013 and 2018. The primary outcome was a composite of heart failure hospitalization and death. Patients with mild TR (n = 324) or significant TR (moderate or greater; n = 60) displayed worse NHYA class and reduced exercise capacity on CPET than those with non-TR (n = 127), but these were more severely impaired in patients with significant TR. A total of 90 patients experienced events over a median follow-up period of 3.3 (interquartile range 0.8-5.5) years. Patients with significant TR displayed a higher risk of events, while patients with mild TR had a 3.0-fold higher risk of events than patients with non-TR (hazard ratio (HR) 3.01; 95% confidence interval (CI), 1.50-6.07). Multivariate Cox regression analysis showed that, compared with non-TR, mild TR was associated with increased adverse events, even after adjustment for co-variates (HR 2.97; 95% CI, 1.35-6.55).

Conclusions: TR severity was associated with worse symptoms, reduced exercise capacity, and poor clinical outcomes. Even patients with mild TR had worse clinical characteristics than those with non-TR.

Keywords: cardiopulmonary exercise testing; chronic heart failure; exercise intolerance; mild tricuspid regurgitation.

Grants and funding

Omote was supported by the JSPS KAKENHI Grant-in-Aid for Young Scientists Start-up (Grant no. 19K23955) and Young Scientists (Grant no. 20K17139 and 23K15089), the Fukuda Foundation for Medical Technology, the Daiwa Securities Health Foundation, and the Hokkaido Heart Association Grant for Research.