TOPLINE:

In a multicentre cardiac magnetic resonance (CMR) study, women with severe tricuspid regurgitation (TR) demonstrated a distinct clinical phenotype, characterised by atrial functional TR, less right ventricular (RV) remodelling, and more than double the 10-year survival rate compared with men.

METHODOLOGY:

• Researchers conducted an ambispective multicentre study at five tertiary hospitals in Spain and included 326 patients (mean age, 71 ± 11 years; 67% women) with severe TR assessed using two-dimensional echocardiography who subsequently underwent CMR.
• Participants were followed up for a maximum of 10 years (median, 35 months), with the primary outcome defined as all-cause mortality under medical therapy; patients undergoing tricuspid valve intervention were censored at the time of the procedure.
• CMR analysis included the quantification of RV and right atrial volumes, RV ejection fraction (RVEF), left ventricular ejection fraction, and tricuspid regurgitant volume (TRVol).
• TR aetiology was categorised into the following four main types on the basis of predominant mechanisms of valve dysfunction: primary or organic TR, secondary atrial TR, secondary ventricular TR, and cardiac implantable electronic device (CIED)-related TR.
• Multivariable Cox regression and propensity-based models assessed sex-related differences in mortality, adjusting for age, comorbidities, TR aetiology, baseline haemoglobin levels, and cardiac function.

TAKEAWAY:

• Women exhibited lower indexed RV end-diastolic and end-systolic volumes (P < .001 for both), higher RVEF (P < .001), and lower TRVol (P = .003) than men.
• Cumulative 1-, 5-, and 10-year survival rates were 96%, 83%, and 53% for women and 89%, 63%, and 25% for men, respectively (P = .001), with women also experiencing fewer hospitalisations due to heart failure than men during follow-up (33% vs 45%; P = .02).
• Male sex remained independently associated with all-cause mortality in multivariable analysis after the inverse probability of treatment weighting (hazard ratio [HR], 2.08; 95% CI, 1.30-3.33; P = .002) and after propensity score matching (HR, 1.81; 95% CI, 1.04-3.15; P = .036).
• Atrial functional TR was the more prevalent aetiology in women, whereas ventricular TR predominated in men (P = .05), with men demonstrating a higher prevalence of diabetes (27% vs 15%; P = .023), coronary artery disease (16% vs 7%; P = .049), and renal dysfunction (46% vs 12%; P < .001).

IN PRACTICE:

"The identification of sex-specific cut-off values for TR severity and RV remodelling parameters may contribute to improved risk stratification and more timely referral for intervention," the authors wrote.

"As transcatheter tricuspid valve therapies continue to evolve, recognition of these sex-specific phenotypes will be essential for optimizing patient selection, timing of intervention, and therapeutic strategies," they added.

SOURCE:

This study was led by Rocio Hinojar, University Hospital Ramón y Cajal, Madrid, Spain. It was published online on April 16, 2026, in European Heart Journal - Cardiovascular Imaging.

LIMITATIONS:

This ambispective study included 80% of prospectively enrolled patients and 20% of retrospectively recruited patients, introducing inherent limitations of the retrospective study design. CIED-related TR was underrepresented in this cohort. The study included multivariable adjustments and inverse probability weighting to account for baseline differences, but residual confounding by unmeasured factors could not be excluded. Haemodynamic parameters related to pulmonary hypertension were not systematically collected. Although the findings suggested higher long-term mortality in men, this observation should not be generalised and should be interpreted with caution.

DISCLOSURES:

The research was supported by the Instituto de Salud Carlos III, co-funded by the European Union. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.