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Background Previous studies have demonstrated that the presence of moderate and severe degree of tricuspid regurgitation (TR) is associated with adverse outcome in patients with heart failure with reduced ejection fraction. However, little is known about the prevalence and prognostic value of TR in patients with stage A, B and C heart failure with preserved ejection fraction (HFpEF). Purpose The aims of this study is to investigate the prevalence and prognostic value of TR in patients with stage A, B and C HFpEF. Methods A total of 2882 patients with stage A (n=904), B (n=1305) and C (n=673) HFpEF from 2013 to 2017 were enrolled. Detailed transthoracic echocardiogram was performed and the severity of TR was graded according to the latest recommendation. Patients were prospectively followed up at our heart failure clinic. Results The average age of the study population was 65 and 47% were male. Hypertension was presence in 58% and diabetes in 33% and the mean left ventricular ejection fraction was 62%. The prevalence of moderate and severe TR increased from stage A to C heart failure (HF) (4.2%, 5.9% and 16.5%, respectively, P&amp;lt;0.01). Kaplan-Meier curve revealed that the presence of moderate and severe degree of TR was associated with all-cause mortality and heart failure hospitalization (Log-rank test P&amp;lt;0.01) (Figure). Multivariable analysis demonstrated that moderate (hazard ratio=1.57, P&amp;lt;0.01) and severe TR (hazard ratio=2.53, P&amp;lt;0.01) was associated with mortality and heart failure hospitalization after adjusting for age, gender, ejection fraction, atrial fibrillation and HF stage. Conclusions The presence of moderate and severe TR is not uncommon in patients with stage A, B and C HFpEF. Importantly, moderate and severe TR was independently associated with mortality and heart failure hospitalization. Kaplan-Meier curve for the impact of TR Funding Acknowledgement Type of funding source: None

The prevalence and prognosis of tricuspid regurgitation in stage A to C heart failure with preserved ejection fraction