Abstract Body (Do not enter title and authors here):
Introduction:
RV dysfunction (RVD) is one of the few cardiovascular conditions with unknown incidence rate (IR). We examined the rates, risk factors, and HF hospitalization hazard associated with incident RVD in pts referred for TTE.

Methods:
We extracted tricuspid regurgitant velocity (TRV) and TAPSE from all TTEs at Vanderbilt between 2010-2023. We selected the first TTE with normal RV function (TAPSE =/> 17mm) and a reported TRV. The primary outcome was new RVD (TAPSE < 17mm) and secondary outcome was time to HF hospitalization after second TTE. We used Poisson regression and multivariable cox models to estimate IRs and hazard ratios, adjusted for demographics, comorbidities, and TTE measures. We estimated a minimum IR in all pts with a baseline echo (Full Cohort) and a maximum IR among pts with a repeat TTE (Repeat TTE Cohort).

Results:
We identified 45,753 pts (63 years [IQR 50-72], 45% Male, 13% Black) with normal RV function at baseline, of whom 13,735 pts (30%) underwent a repeat TTE and 4,198 pts (10%) developed RVD. The IR of RVD in the Full Cohort was 3.2/100 person-yrs (95%CI 3.1-3.3) and 8.2 (95%CI 8.0-8.5) in the Repeat TTE Cohort. IRs were higher in pts with pulmonary hypertension vs without and increased with higher RVSP (Figure 1). Risk factors for incident RVD included HF (HR 1.88; 95%CI 1.75–2.03), AF (HR 1.54; 95%CI 1.44–1.65), and left-sided valvular disease (HR 1.68; 95%CI 1.53–1.85). Baseline RVSP was associated with TAPSE decline beginning near 35mmg (Figure 2A). Incident RVD was associated with increased hazard of HF hospitalization (HR 2.02; 95% CI 1.85-2.21). Hazard of HF hospitalization increased when TAPSE declined 5mm or greater (Figure 2B).

Conclusions:
RVD incidence is substantial among patients referred for TTE and warrants close monitoring when RVSP >35mmHg. Incident RVD and change in TAPSE >5mm were associated with increased hazard of HF hospitalization, even after adjustment for prevalent HF.