Prognostic value of peak tricuspid regurgitation velocity in hospitalized patients with heart failure with preserved ejection fraction: an multi-institutional study

Objective: Heart failure with preserved ejection fraction (HFpEF) represents a significant clinical challenge with limited prognostic markers. The prognostic value of Doppler-derived peak tricuspid regurgitation velocity (TRVmax) in HFpEF patients remains underexplored. Methods: This retrospective cohort study analysed 6,438 patients with HFpEF hospitalized for acute heart failure between 2007 and 2018. Patients were stratified into three groups based on baseline TRVmax values: ≤2.8 m/s, 2.9–3.4 m/s and >3.4 m/s. The primary outcome was a composite of heart failure rehospitalization and cardiovascular mortality. Association between TRVmax levels and the risks of outcome was evaluated using Cox proportional hazards model with adjustment for established risk factors. Results: During the median follow-up of 2 years (interquartile range: 0.8–4 years), increasing incidence rates of the composite outcome were observed across the three groups (17.8, 21.2 and 23.9 per 100 person-years, respectively). Compared to the TRVmax ≤2.8 m/s group, significantly higher risks were observed in the TRVmax 2.9–3.4 m/s group (adjusted HR: 1.11, 95% CI: 1.003–1.22) and TRVmax >3.4 m/s group (adjusted HR: 1.23, 95% CI: 1.09–1.39). Each 0.5 m/s increase in TRVmax was associated with a 7% increase in composite outcome risk (HR: 1.07, 95% CI: 1.04–1.10). Conclusions: TRVmax exceeding 2.8 m/s has prognostic value for heart failure rehospitalization and cardiovascular mortality in HFpEF patients, suggesting its potential utility as a risk stratification tool in this population.