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The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR.We enrolled 373 consecutive patients (mean age 68 ±11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1–120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36 ±2% and 55 ±4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1–2.1, P = 0.01) was an independent determinant of HF. The incidence of HF was 41 ±5, 46 ±7, 57 ±7, and 65 ±8% for patients without, and with mild, moderate, and severe FTR respectively (P = 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5 ±2% and 60 ±3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2–2.1, P = 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69 ±2.5, 67 ±2.1, 51 ±2.5, and 40 ±4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P = 0.004).Moderate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.