Abstract Body (Do not enter title and authors here):

Introduction: Tricuspid regurgitation (TR) can have detrimental effects on heart failure (HF) patients clinically, and there is growing evidence supporting this association. We aim to study the impact of the severity of TR on the long-term outcomes in patients with HF.

Methods: We systematically screened PubMed, SCOPUS, and Google Scholar databases up to May 2024 using appropriate keywords. The outcomes studied included 1-year mortality, 2-year mortality, HF hospitalizations, cardiovascular deaths, and composite events (HF hospitalization and mortality). The majority of studies included Journal of the American Society of Echocardiography 2017 guidelines to assess the severity of TR. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a binary random effects model. Heterogeneity was assessed using I2 statistics, and a leave-one-out analysis was performed. A p-value of <0.05 was considered significant.

Results: A total of 10 studies with 456,353 HF patients were included. The mean age of the included population was 71.2 years, with 59.4% of male participants having a median follow-up of 2 years. Severe TR showed a significant association with higher odds of 1-year mortality (OR=1.25 [1.02-1.52], p=0.03; I2=78.15%), 2-year mortality (OR=1.63 [1.28-2.09], p<0.01; I2=0%), HF hospitalization (OR=1.39 [1.14-1.71], p<0.01; I2=61.58%), and composite events (OR=1.44 [1.10-1.88], p<0.01; I2=73.46%). However, it showed no association with cardiovascular deaths (OR=1.35 [0.82-2.24], p=0.24; I2=78.31%). Upon performing a leave-one-out sensitivity analysis, we found that excluding Adamo's study changed the overall OR to 1.34 (95% CI: 1.29, 1.39), indicating its influence on the estimate. The narrower CI and increased OR suggest Adamo's study has a relatively lower effect on overall mortality risk compared to the pooled effect of the other studies.

Conclusion: Severe TR is associated with a higher risk of 1-year and 2-year mortality, HF hospitalizations, and composite events among heart failure patients. Therefore, HF patients with comorbid TR should be promptly screened and managed, as increasing severity is linked to a higher risk of adverse outcomes.