{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T20:54:39Z","timestamp":1782939279949,"version":"3.54.5"},"reference-count":39,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T00:00:00Z","timestamp":1780704000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Italian Ministry of University and Research","doi-asserted-by":"publisher","award":["2022Y7HHNW"],"award-info":[{"award-number":["2022Y7HHNW"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We aimed to assess the prognostic role of untreated moderate-to-severe tricuspid regurgitation (TR) by a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed from database inception to 14 August 2025. Studies reporting data on clinical outcomes associated with different TR grades not receiving treatment were considered eligible. The primary endpoint was all-cause mortality; secondary endpoints included cardiovascular (CV) mortality and heart failure (HF) hospitalization. Pooled estimates were calculated using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our literature search yielded 2727 articles, of which 225 were assessed for full-text eligibility. A total of 106 studies (107 comparisons) comprising 961 136 patients, were included in the quantitative synthesis. The overall prevalence of untreated moderate-to-severe TR was 13.5% but varied widely across population subgroups. Moderate-to-severe TR was associated with a significantly higher risk of all-cause mortality compared with none-to-mild TR [unadjusted hazard ratio (HR) 2.07; 95% confidence interval (CI) 1.89\u20132.26; P &amp;lt; .001]. The association was confirmed in adjusted models and among different subgroups (i.e. patients performing a general echocardiographic irrespective of indication, patients with left-side valvular heart disease [LSVHD], HF without LSVHD, patients undergoing cardiac electronic device implantation, left ventricular assist device recipients and in patients with pulmonary artery hypertension), but not after heart transplantation. A stepwise increase in mortality was observed with increasing TR severity. Moderate-to-severe TR was also associated with higher risk of CV mortality and HF hospitalization (HR 1.92 [1.64\u20132.26] and HR 1.63[1.44\u20131.84], respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Untreated moderate-to-severe TR is associated with higher risk of all-cause mortality, CV mortality and HF hospitalization, underlying the role of timely diagnosis and appropriate management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag192","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:46:44Z","timestamp":1780660004000},"source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and prognostic role of untreated moderate-to-severe tricuspid regurgitation: a systematic review and meta-analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7584-2857","authenticated-orcid":false,"given":"Daniela","family":"Tomasoni","sequence":"first","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-6446","authenticated-orcid":false,"given":"Chiara","family":"Oriecuia","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Universit\u00e0 degli Studi di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-1815","authenticated-orcid":false,"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ravasio","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, ASST Spedali Civili Di Brescia, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Nava","sequence":"additional","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Costa","sequence":"additional","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-7871","authenticated-orcid":false,"given":"Matteo","family":"Pagnesi","sequence":"additional","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Mario","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1443-7874","authenticated-orcid":false,"given":"Claudia","family":"Specchia","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Universit\u00e0 degli Studi di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,6]]},"reference":[{"key":"2026061714095650200_xuag192-B1","doi-asserted-by":"publisher","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart J"},{"key":"2026061714095650200_xuag192-B2","doi-asserted-by":"publisher","first-page":"791","DOI":"10.4244\/EIJ-D-21-00695","article-title":"Transcatheter treatment for tricuspid valve disease","volume":"17","author":"Praz","year":"2021","journal-title":"EuroIntervention"},{"key":"2026061714095650200_xuag192-B3","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: a population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"2026061714095650200_xuag192-B4","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1161\/CIRCULATIONAHA.118.038946","article-title":"Excess mortality associated with functional tricuspid regurgitation complicating heart failure with reduced ejection fraction","volume":"140","author":"Benfari","year":"2019","journal-title":"Circulation"},{"key":"2026061714095650200_xuag192-B5","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.jchf.2023.11.018","article-title":"Tricuspid regurgitation and clinical outcomes in heart failure with reduced ejection fraction","volume":"12","author":"Adamo","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026061714095650200_xuag192-B6","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1002\/ejhf.2858","article-title":"Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum","volume":"25","author":"Heitzinger","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B7","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1093\/ehjci\/jeae060","article-title":"Prevalence and clinical outcomes of isolated or combined moderate to severe mitral and tricuspid regurgitation in patients with cardiac amyloidosis","volume":"25","author":"Tomasoni","year":"2024","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026061714095650200_xuag192-B8","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1002\/ejhf.2929","article-title":"Prevalence, clinical characteristics and outcomes of heart failure patients with or without isolated or combined mitral and tricuspid regurgitation: an analysis from the ESC-HFA heart failure long-term registry","volume":"25","author":"Adamo","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B9","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jacc.2008.09.048","article-title":"Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management","volume":"53","author":"Shiran","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2026061714095650200_xuag192-B10","doi-asserted-by":"publisher","first-page":"102493","DOI":"10.1016\/j.jchf.2025.04.008","article-title":"Current evidence on tricuspid regurgitation interventions in heart failure","volume":"13","author":"Hahn","year":"2025","journal-title":"JACC Heart Fail"},{"key":"2026061714095650200_xuag192-B11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.121.012948","article-title":"Worsened tricuspid regurgitation following pericardiectomy for constrictive pericarditis","volume":"14","author":"Tabucanon","year":"2021","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026061714095650200_xuag192-B12","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1161\/CIRCULATIONAHA.124.070411","article-title":"Evidence generation and implementation of transcatheter interventions for atrioventricular valvular heart disease in heart failure: current Status and future directions","volume":"151","author":"Metra","year":"2025","journal-title":"Circulation"},{"key":"2026061714095650200_xuag192-B13","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1002\/ejhf.3106","article-title":"Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC","volume":"26","author":"Adamo","year":"2024","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B14","doi-asserted-by":"publisher","first-page":"4508","DOI":"10.1093\/eurheartj\/ehad653","article-title":"Tricuspid valve academic research consortium definitions for tricuspid regurgitation and trial endpoints","volume":"44","author":"Hahn","year":"2023","journal-title":"Eur Heart J"},{"key":"2026061714095650200_xuag192-B15","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1093\/eurheartj\/ehy641","article-title":"Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis","volume":"40","author":"Wang","year":"2019","journal-title":"Eur Heart J"},{"key":"2026061714095650200_xuag192-B16","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1002\/ehf2.15303","article-title":"Association between tricuspid regurgitation and heart failure outcomes: a meta-analysis","volume":"12","author":"Sun","year":"2025","journal-title":"ESC Heart Fail"},{"key":"2026061714095650200_xuag192-B17","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.jcin.2024.10.034","article-title":"Tricuspid regurgitation disease stages and treatment outcomes after transcatheter tricuspid valve repair","volume":"18","author":"Schlotter","year":"2025","journal-title":"JACC Cardiovasc Interv"},{"key":"2026061714095650200_xuag192-B18","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1002\/ejhf.3757","article-title":"Heart failure hospitalizations and clinical outcomes in patients undergoing tricuspid transcatheter edge-to-edge repair: insights from EuroTR","volume":"27","author":"Tomasoni","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B19","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1161\/CIRCULATIONAHA.125.074536","article-title":"Two-year outcomes of transcatheter edge-to-edge repair for severe tricuspid regurgitation: the TRILUMINATE pivotal randomized controlled trial","volume":"151","author":"Kar","year":"2025","journal-title":"Circulation"},{"key":"2026061714095650200_xuag192-B20","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1056\/NEJMoa2300525","article-title":"Transcatheter repair for patients with tricuspid regurgitation","volume":"388","author":"Sorajja","year":"2023","journal-title":"N Engl J Med"},{"key":"2026061714095650200_xuag192-B21","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"3","author":"Moher","year":"2009","journal-title":"Open Med"},{"key":"2026061714095650200_xuag192-B22","author":"Wells"},{"key":"2026061714095650200_xuag192-B23"},{"key":"2026061714095650200_xuag192-B24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1471-2288-12-9","article-title":"Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves","volume":"12","author":"Guyot","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"2026061714095650200_xuag192-B25","doi-asserted-by":"publisher","first-page":"101484","DOI":"10.1016\/j.cegh.2023.101484","article-title":"Introduction to the GRADE tool for rating certainty in evidence and recommendations","volume":"25","author":"Prasad","year":"2023","journal-title":"Clin Epidemiol Glob Health"},{"key":"2026061714095650200_xuag192-B26","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.jcmg.2018.06.014","article-title":"Burden of tricuspid regurgitation in patients diagnosed in the community setting","volume":"12","author":"Topilsky","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026061714095650200_xuag192-B27","doi-asserted-by":"publisher","first-page":"200","DOI":"10.2459\/JCM.0000000000001582","article-title":"Characteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure","volume":"25","author":"Pagnesi","year":"2024","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2026061714095650200_xuag192-B28","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"Authors\/Task Force Members","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B29","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.cardfail.2021.04.010","article-title":"Heart Failure Association, Heart Failure Society of America, and Japanese Heart Failure Society Position Statement on Endomyocardial Biopsy","volume":"27","author":"Seferovic","year":"2021","journal-title":"J Card Fail"},{"key":"2026061714095650200_xuag192-B30","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1002\/ejhf.3678","article-title":"Aetiological phenotypes of atrial and ventricular secondary tricuspid regurgitation and their prognostic implications: insights from the CARE-TR registry","volume":"27","author":"Lupi","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B31","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.122.011958","article-title":"Atrial functional tricuspid regurgitation: novel definition and impact on prognosis","volume":"15","author":"Schlotter","year":"2022","journal-title":"Circ Cardiovasc Interv"},{"key":"2026061714095650200_xuag192-B32","doi-asserted-by":"publisher","first-page":"2781","DOI":"10.1016\/j.jcin.2024.10.028","article-title":"Atrial secondary tricuspid regurgitation: insights into the EuroTR Registry","volume":"17","author":"Stolz","year":"2024","journal-title":"JACC Cardiovasc Interv"},{"key":"2026061714095650200_xuag192-B33","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.039989","article-title":"Association of diuretic dosage with outcomes in patients with hemodynamically significant isolated tricuspid valve regurgitation","volume":"14","author":"Anand","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026061714095650200_xuag192-B34","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.jcmg.2023.12.011","article-title":"Right heart remodeling and outcomes in patients with tricuspid regurgitation: a literature review and meta-analysis","volume":"17","author":"Bombace","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026061714095650200_xuag192-B35","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1002\/ejhf.2637","article-title":"Evolution of tricuspid regurgitation after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation and its impact on mortality","volume":"24","author":"Adamo","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026061714095650200_xuag192-B36","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1093\/eurheartj\/ehab679","article-title":"TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery","volume":"43","author":"Dreyfus","year":"2022","journal-title":"Eur Heart J"},{"key":"2026061714095650200_xuag192-B37","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1093\/ehjci\/jex139","article-title":"The need for a new tricuspid regurgitation grading scheme","volume":"18","author":"Hahn","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026061714095650200_xuag192-B38","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1093\/ejechocard\/jeq031","article-title":"European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease)","volume":"11","author":"Lancellotti","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2026061714095650200_xuag192-B39","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjhf\/advance-article-pdf\/doi\/10.1093\/ejhf\/xuag192\/68484251\/xuag192.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/advance-article-pdf\/doi\/10.1093\/ejhf\/xuag192\/68484251\/xuag192.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T18:10:04Z","timestamp":1781719804000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/advance-article\/doi\/10.1093\/ejhf\/xuag192\/8703350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,6]]},"references-count":39,"URL":"https:\/\/doi.org\/10.1093\/ejhf\/xuag192","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,6]]},"article-number":"xuag192"}}