{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:05:07Z","timestamp":1789005907721,"version":"build-2803163510"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,7,15]]},"abstract":"<jats:sec id=\"jah311119-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Tricuspid valve surgery is recommended for severe isolated tricuspid regurgitation (TR) if symptoms persist despite optimal medical therapy. The definition of optimal therapy for TR is unclear beyond managing underlying conditions. Diuretics are the primary treatment for volume retention in TR, but it is unknown whether a \u201csafe diuretic dose\u201d exists for conservative management. We sought to evaluate the association between diuretic dose and outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311119-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Adult patients with \u2265moderate\u2013severe isolated TR were retrospectively identified from echocardiographic reports. Clinical and echocardiographic data were extracted from electronic medical records and manually reviewed. The primary end point was all\u2010cause mortality. Loop diuretic doses were converted to furosemide equivalent and categorized into 4 groups: &lt;40\u2009mg, 40 to 79\u2009mg, 80 to 159\u2009mg, and \u2265160\u2009mg daily.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311119-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of 1302 patients (age 72\u00b113\u2009years, 60% female), 565 (43%) had moderate\u2013severe TR and 737 (57%) had severe TR. Median follow\u2010up was 8.7 (1.4, 14.0) years. Comorbidities increased with higher diuretic doses. A linear relationship between diuretic dose and mortality was observed in spline\u2010curve analysis. Hazard ratios (and CIs) for mortality adjusted for age, sex, coronary disease, chronic kidney disease, mild pulmonary hypertension, and New York Heart Association III\/IV symptoms were 1.21 (0.96\u20131.53) (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.12) for &lt;40\u2009mg, 1.50 (1.23\u20131.82) (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001) for 40 to 79\u2009mg, 1.86 (1.46\u20132.37) (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001) for 80 to 159\u2009mg, and 2.90 (2.18\u20133.88) (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001) for \u2265160\u2009mg furosemide equivalent. Any diuretic dose was associated with significant symptoms (New York Heart Association III\u2013IV), with more patients experiencing symptoms at higher doses.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311119-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">A daily loop diuretic dose \u226540\u2009mg furosemide equivalent is associated with increased mortality and greater symptom severity in patients with TR.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.039989","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T10:25:32Z","timestamp":1752488732000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Association of Diuretic Dosage With Outcomes in Patients With Hemodynamically Significant Isolated Tricuspid Valve Regurgitation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7580-1314","authenticated-orcid":false,"given":"Vidhu","family":"Anand","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]},{"name":"Mayo Clinic Health System","place":["Eau Claire"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1340-0647","authenticated-orcid":false,"given":"Christopher G.","family":"Scott","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Ali","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6095-5579","authenticated-orcid":false,"given":"Vuyisile T.","family":"Nkomo","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4489-2349","authenticated-orcid":false,"given":"Jeremy J.","family":"Thaden","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garvan C.","family":"Kane","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel D.","family":"Borgeson","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-0596","authenticated-orcid":false,"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3820-0473","authenticated-orcid":false,"given":"Cristina","family":"Pislaru","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-5379","authenticated-orcid":false,"given":"Mackram F.","family":"Eleid","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5415-1478","authenticated-orcid":false,"given":"Juan A.","family":"Crestanello","sequence":"additional","affiliation":[{"name":"Mayo Clinic Health System","place":["Eau Claire"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-3521","authenticated-orcid":false,"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5256-3150","authenticated-orcid":false,"given":"Sorin V.","family":"Pislaru","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.06.014"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.10.055"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy641"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2022.05.015"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab679"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.038"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.01.016"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007597"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.039"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000932"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.09.027"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2024.04.013"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2024.04.013"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jead070"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.02.020"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.04.003"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.12.012"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.07.035"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.018417"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.02.013"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad585"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1080101"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2300525"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.039989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T10:11:16Z","timestamp":1752660676000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.039989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":24,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2025,7,15]]}},"alternative-id":["10.1161\/JAHA.124.039989"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.039989","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"2024-11-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e039989"}}