Behind the Science: Tricuspid Regurgitation in HFpEF | JACC

In JACC's inaugural Behind the Science episode, Adith Arun, sits down with senior author Barry A. Borlaug, MD, to discuss his latest study published in JACC's December 16, 2025 issue, examining tricuspid regurgitation (TR) across the full spectrum of HFpEF. The study found that TR is common even in early HFpEF, with ventricular secondary TR (VSTR) representing the predominant pattern (≈26% vs. ≈8% ASTR). VSTR was closely associated with pulmonary vascular disease, greater right atrial enlargement, and significantly higher risks of HF hospitalization and mortality. The study also highlighted the limitations of using atrial fibrillation to define ASTR—nearly 46% of patients categorized as ASTR had no prior AFib. Importantly, clinically meaningful TR was observed even in exercise-only HFpEF, reinforcing the value of exercise hemodynamic testing for earlier detection.