August 2024 - Gregor Heitzinger

Dr. Gregor Heitzinger, PhD

MedUni Wien RESEARCHER OF THE MONTH August 2024

Secondary tricuspid regurgitation: more than a mere bystander

Secondary tricuspid regurgitation (sTR) is a common echocardiographic finding in patients with heart failure. However, insights into epidemiology, impact, and treatment of sTR across the entire heart failure (HF) spectrum are lacking, yet are necessary for informed healthcare decision-making. This population-based study included data from 13 469 patients with HF and sTR from the Viennese community over a 10-year period. Severe sTR was most prevalent in patients with reduced ejection fraction and was associated with excess mortality in all heart failure subtypes. Patients with mild sTR already had a significantly impaired survival in comparison to an age- and sex-matched community independent of the underlying HF subtype. Despite high mortality rates and availability of state-of-the- art facilities, sTR was rarely treated, surgically or percutaneously. With the projected increase in HF prevalence and population ageing, the data suggest a major burden for healthcare systems that needs to be adequately addressed.

Selected Literature

1. Heitzinger G, Pavo N, Koschatko S, Jantsch C, Winter MP, Spinka G, et al. Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum. Eur J Heart Fail. 2023.

2. Topilsky Y, Maltais S, Medina Inojosa J, Oguz D, Michelena H, Maalouf J, et al. Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting. JACC Cardiovasc Imaging. 2019;12(3):433-42.

3. Bartko PE, Arfsten H, Frey MK, Heitzinger G, Pavo N, Cho A, et al. Natural History of Functional Tricuspid Regurgitation: Implications of Quantitative Doppler Assessment. JACC Cardiovasc Imaging. 2019.

4. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726.

5. Bartko PE, Heitzinger G, Pavo N, Heitzinger M, Spinka G, Prausmuller S, et al. Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ. 2021;373:n1421.

6. Bartko PE, Arfsten H, Heitzinger G, Pavo N, Toma A, Strunk G, et al. A Unifying Concept for the Quantitative Assessment of Secondary Mitral Regurgitation. J Am Coll Cardiol. 2019;73(20):2506-17.

7. Heitzinger G, Spinka G, Prausmüller S, Pavo N, Dannenberg V, Donà C, et al. Tailored Risk Stratification in Severe Mitral Regurgitation and Heart Failure Using Supervised Learning Techniques. JACC: Advances. 2022;1(3):100063.

8. Heitzinger G, Spinka G, Koschatko S, Baumgartner C, Dannenberg V, Halavina K, et al. A streamlined, machine learning-derived approach to risk-stratification in heart failure patients with secondary tricuspid regurgitation. Eur Heart J Cardiovasc Imaging. 2023;24(5):588-97.

9. Dreyfus J, Galloo X, Taramasso M, Heitzinger G, Benfari G, Kresoja KP, et al. TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. Eur Heart J. 2024;45(8):586-97.