Tricuspid regurgitation disease stages predict treatment outcomes after transcatheter tricuspid valve repair

Clin Res Cardiol (2024). DOI 10.1007/s00392-024-02406-5
F. Schlotter (Leipzig)¹, L. Stolz (München)², K.-P. Kresoja (Leipzig)¹, F. Praz (Bern)³, R. Estévez-Loureiro (Vigo)⁴, F. Maisano (Milano)⁵, E. Van Belle (Lille)⁶, D. Kalbacher (Hamburg)⁷, C. Iliadis (Köln)⁸, N. Karam (Paris)⁹, V. Rudolph (Bad Oeynhausen)¹⁰, M. Metra (Brescia)¹¹, R. S. von Bardeleben (Mainz)¹², H. Lapp (Bad Berka)¹³, P. Lüdike (Essen)¹⁴, P. Raake (Augsburg)¹⁵, S. Toggweiler (Luzern)¹⁶, P. Boekstegers (Siegburg)¹⁷, A. Rück (Stockholm)¹⁸, T. Geisler (Tübingen)¹⁹, M. Keßler (Ulm)²⁰, H. Thiele (Leipzig)¹, K.-P. Rommel (Leipzig)¹, A. Lauten (Erfurt)²¹, J. Hausleiter (München)², P. Lurz (Mainz)^22
1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; ²LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; ³Inselspital, University of Bern Department of Cardiology Bern, Schweiz; ⁴University Hospital Alvaro Cunqueiro Interventional Cardiology Clinic Vigo, Spanien; ⁵San Raffaele Division of Cardiology and Department of Cardiac Surgery Milano, Italien; ⁶Institut Cœur Poumon, Inserm U1011, Institut Pasteur de Lille, France Département de Cardiologie Lille, Frankreich; ⁷Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; ⁸Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; ⁹European Hospital, Georges Pompidou, Paris, France; and the eUniversity of Paris, PARCC, INSERM, Paris, France Advanced Heart Failure Unit Paris, Frankreich; ¹⁰Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ¹¹University of Brescia Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Brescia, Italien; ¹²Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie im Herz- und Gefäßzentrum Mainz, Deutschland; ¹³Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; ¹⁴Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; ¹⁵Universitätsklinikum Augsburg I. Medizinische Klinik Augsburg, Deutschland; ¹⁶Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. Luzern, Schweiz; ¹⁷HELIOS Klinikum Siegburg Siegburg, Deutschland; ¹⁸Karolinska University Hospital, SE-171 76 Stockholm, Sweden. Department of Cardiology Stockholm, Schweden; ¹⁹Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; ²⁰Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; ²¹Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; ²²Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland

Background: Tricuspid valve edge-to-edge repair (T-TEER) emerged as a treatment option for patients with severe tricuspid regurgitation (TR), however, randomized trials have not shown a survival benefit, possibly due to inclusion of patients in early or advanced disease stages. We sought to investigate the association of TR disease stages with outcomes following TTVR.

Methods: In total, 1885 patients with significant TR were analyzed, including 585 conservatively treated individuals and 1300 patients who received T-TEER, and were evaluated as part of the prospective EURO-TR registry. Patients were grouped into early, intermediate and late disease stages based on left and right ventricular functional parameters as well as renal function and natriuretic peptide levels. One-year mortality was evaluated to reveal T-TEER treatment effects. Procedural success was defined as postprocedural TR <3°.

Results: Overall, 395 patients (21%) were categorized into early, 1173 patients (62%) as intermediate and 317 patients (17%) as late stage TR. Event rates were lowest in the early stage and highest in late stage. While, survival was not affected by T-TEER in the early and late stage, in the intermediate stage, T-TEER was associated with a survival benefit (p=0.04). T-TEER benefit showed a u-shaped relationship with TR disease stage, with the highest treatment effect in patients in intermediate disease stages.

Conclusion: In a large cohort study, T-TEER was associated with a survival benefit as compared to medical therapy in patients in an intermediate diseases stage, while outcomes were neither affected in early nor late stages. Timing of T-TEER with regard to disease stages might be crucial to optimize treatment benefits.