Aims: To determine whether a simplified, previously proposed two-dimensional (2D) approach to RV volume assessment can provide adjunctive prognostic information in patients undergoing Transcatheter Tricuspid Valve Interventions (TTVI).
Methods and results: In this prospective single-centre study, 113 patients undergoing TTVI were included (T-TEER; n=91, heterotopic caval valve implantation; n=17, and orthotopic transcatheter tricuspid valve replacement; n=5). RV end-diastolic and end-systolic volumes were calculated using a previously described 2D-based geometric model (Al Alteah et al. PLoS One. 2023 Aug 18;18(8)). The primary endpoint was a composite of all-cause mortality or heart failure rehospitalisation at 1 year. The primary endpoint occurred in 47 patients (41.6%). In univariable Cox regression analysis, both RVEDVi (HR 1.05 per 10 mL/m², 95% CI 1.01–1.10, p=0.03) and RVESVi (HR 1.13 per 10 mL/m², 95% CI 1.01–1.25, p=0.03) were associated with adverse outcome. Receiver operating characteristic analysis identified optimal cut-off values of 90 mL/m² for RVEDVi and 35 mL/m² for RVESVi. Patients above these thresholds (diastolic, systolic, or both) showed significantly reduced event-free survival (log-rank p<0.01). In a multivariable Cox regression analysis, RV dilatation showed a trend toward worse outcomes (HR 2.09, 95% CI 0.91–4.80, p=0.08), whereas the TriScore remained independently associated with outcome (HR 1.30, 95% CI 1.10–1.53, p < 0.01).
Conclusion: RV volumes derived from a simple 2D echocardiographic model are associated with clinical outcomes in patients undergoing TTVI and may provide adjunctive information for risk stratification in routine clinical practice.
