Management of Patient With Tricuspid Regurgitation and Heart Failure With Preserved Ejection Fraction.

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) and tricuspid regurgitation are increasingly recognized as interrelated conditions with overlapping management approaches.

CASE SUMMARY: A 69-year-old woman presented with worsening palpitations and exertional dyspnea. Her symptoms, in combination with a preserved ejection fraction and evidence of increased left ventricular filling pressures, were indicative of HFpEF. Echocardiographic examination revealed torrential tricuspid regurgitation. Guideline-directed medical therapy was optimized, resulting in improvement of tricuspid regurgitation severity.

DISCUSSION: Recent guidelines for HFpEF management emphasize the use of diuretics for symptom control and the addition of sodium-glucose cotransporter 2 inhibitors and sacubitril-valsartan to improve outcomes. The case underscores the importance of addressing the underlying hemodynamic contributors to tricuspid regurgitation before considering surgical or catheter-based interventions.

TAKE-HOME MESSAGES: Guideline-directed medical therapy for HFpEF plays a crucial role in symptom relief, improves outcomes, and may help reduce tricuspid regurgitation severity.