Herzmedizin

The GLIDE Score is Associated with Procedural Success in Patients Undergoing Direct Transcatheter Tricuspid Valve Annuloplasty

J. L. Althoff (Köln)1, M. Gercek (Bad Oeynhausen)2, D. Mehrkens (Köln)3, F. Rudolph (Bad Oeynhausen)2, T. Gietzen (Köln)3, J. Kirchner (Bad Oeynhausen)4, C. Hasse (Köln)3, J. von Stein (Köln)5, P. von Stein (Köln)3, K. Finke (Köln)5, J. Wrobel (Köln)3, L. Marx (Köln)3, C. Iliadis (Köln)3, K. Friedrichs (Bad Oeynhausen)4, V. Rudolph (Bad Oeynhausen)2, S. Baldus (Köln)5, R. Pfister (Köln)3, M. I. Körber (Köln)3
1Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 4Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland; 5Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland
Background:
Transcatheter tricuspid valve annuloplasty (TTVA) provides an interventional treatment option for patients with severe tricuspid regurgitation (TR) who are anatomically unsuitable for transcatheter edge-to-edge repair. The recently published GLIDE Score (including septolateral gap, predominant jet location, image quality, chordal structure density, and en-face TR jet morphology) may predict successful tricuspid TEER. However, its value in patients undergoing TTVA remains unknown.

Methods:
This study included 204 consecutive patients who underwent TTVA between 2018 and 2023 at two tertiary centers in Germany. The primary outcome assessed was intraprocedural success, as defined by the TVARC criteria. Additional outcomes were defined as TR reduction of ≥2 grades and residual TR grade ≤2. 

Results:
The study population was mostly female (77.5%), and the median age was 79 years (74–82). In this cohort, the median GLIDE Score was 3 (1–4), with 53% of patients having a score of 3 or higher. Intraprocedural success, as defined by the TVARC criteria, was achieved in 146 out of 204 procedures (71.6%). A TR reduction of >2 grades was achieved in 83.7%, and a residual TR grade ≤2 in 72.8%.

Univariate regression analysis identified the GLIDE Score as being strongly associated with intraprocedural success (p<0.001), TR reduction of ≥2 grades (p=0.001), and residual TR grade ≤2 (p<0.001). When examining the individual components, significant results were observed for all variables, except chordal structure density, in relation to the endpoints of residual TR grade ≤2 and intraprocedural success. For TR reduction of ≥2 grades, significant associations were found with predominant jet location and image quality, while septolateral gap and en face TR were just above the significance level (p=0.06). 

Intraprocedural success was 96.8% for patients with a GLIDE Score of 0–1, compared to 44.8% for those with a score of ≥4 (Figure 1). Following adjustment for baseline TR in multivariable regression analysis, the GLIDE Score remained significantly associated with all three outcomes. The area under the ROC curve for achieving intraprocedural success was 0.77 (95% CI: 0.71 – 0.84) with an optimal cut-off of 2.5.

Conclusion:
The GLIDE Score is strongly associated with acute procedural efficacy in patients with severe functional TR undergoing TTVA. Incorporating the GLIDE Score into clinical practice may offer incremental value for tailoring transcatheter tricuspid repair techniques during patient screening.

 


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