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Marked Underreferral to Structural Heart Specialists in Severe Tricuspid Regurgitation Despite High Clinical Burden: An Adjusted Registry Analysis

Year: 2026

Type: article

Abstract: Background: Severe tricuspid regurgitation (TR) carries mortality risk comparable to untreated severe aortic stenosis, yet specialist referral rates remain poorly characterized. Methods: We analyzed 1000 patients with severe TR from CardioCare registry from a single center in Georgia. The primary outcome was the absence of structural heart disease (SHD) specialist evaluation. Multivariable logistic regression identified predictors of referral failure adjusted for age, heart failure (HF), kidney and liver disease, symptoms, right ventricular systolic pressure (RVSP), and ejection fraction, with an extended model adding coronary artery disease, conduction delay, and New York Heart Association (NYHA) class III-IV. Kaplan-Meier and Cox analyses assessed survival by evaluation status and clinical subgroup. Results: < 0.001). Only 13.2% of symptomatic patients without HF were evaluated, and those with combined HF, kidney, and liver disease had the highest mortality (22.4%) but no preferential referral. Survival was worse with HF, increasing organ burden, and RVSP ≥40 mmHg; these factors plus age remained independent mortality predictors on Cox analysis, though this association attenuated in sensitivity analysis. Conclusions: More than two-thirds of patients with severe TR never reach an SHD specialist despite substantial clinical burden, highlighting the need for echocardiography-triggered referral pathways and quality metrics.

Source: Structural Heart

DOI: 10.1016/j.shj.2026.101075