Natural History of Severe TR — EECC MCQ

Correct answer: D — Severe TR is independently associated with reduced survival — 5-year mortality approaches 50%; symptoms of RV failure (oedema, ascites, hepatomegaly, cachexia) and progressive RV dysfunction characterise the advanced stages

Severe TR has been historically undertreated ('the forgotten valve'), but accumulating evidence demonstrates significant adverse prognostic impact. Large registry studies show: moderate-severe TR is independently associated with reduced survival even after adjusting for LV function, PH, and AF. The 2025 ESC VHD Guidelines emphasise earlier referral for TR intervention based on this evidence. Natural history of untreated severe TR: progressive RV dilatation → RV dysfunction → right heart failure (peripheral oedema, hepatic congestion, ascites, cardiac cachexia, renal impairment from venous congestion). Once RV dysfunction is established, outcomes of TV intervention are worse — supporting earlier referral. The emerging transcatheter TV intervention options (TriClip, EVOQUE) provide less invasive treatment for patients at high surgical risk.

Reference: ESC/EACTS (2025): VHD Guidelines