Background: Severe tricuspid regurgitation (TR) is often associated with left-sided heart failure (HF) and both conditions are associated with impaired prognosis. Transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as a therapeutic option for patients with severe TR, but little is known about the impact of left-sided HF in those patients. We therefore aimed to assess the role of T-TEER across the spectrum of left ventricular ejection fraction (LVEF).
Methods: Using the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR registry) the impact of LVEF on 1-year all-cause mortality after T-TEER was investigated. Patients were divided according to LVEF as HFrEF (LVEF ≤40%), HFmrEF (LVEF 41-49%) and preserved LVEF (LVEF ≥50%) whereas the latter group was further stratified according to pulmonary-capillary wedge pressure (PCWP) ≤/> 15 mmHg.
Results: A total of 1.670 patients were included in the analysis (mean age 79±7 years, 53% ♀). Overall, 250 patients (15%) presented with HFrEF, 252 (15%) with HFmrEF and 1.168 (70%) had preserved LVEF. Of those, data for PCWP were available for 607 patients (52%), whereas 214 (35%) had PCWP ≤15mmHg further referred to as isolated right heart failure (iRHF) and 393 (65%) PCWP >15mmHg further referred to as HFpEF patients.
Irrespective of LVEF, New-York Heart Association functional class showed improvement in all patients (p<0.001). Kaplan-Meier curves showed a strong discrimination with regards to all-cause mortality for LVEF, with highest mortality observed in patients with HFrEF, followed by HFmrEF and lowest mortality in patients with preserved LVEF (p log-rank=0.002, Figure 1A). Stratifying patients with preserved LVEF according to filling pressures showed that HFpEF patients had worse survival as compared to iRHF patients (p log-rank=0.004, Figure 1B). While residual TR severity ≤II following T-TEER was comparable between HF entities (~77%), patients with iRHF showed best results (residual TR ≤II 87%, p=0.002).
Conclusion: Most patients undergoing T-TEER present with left-sided HF, with HFpEF being the predominant entity. All subgroups showed functional improvements irrespective of the underlying left-sided HF phenotype, but outcomes are worst alongside decreasing LVEF. In patients with iRHF the highest procedural success rates and lowest 1-year mortality were observed, for the first time showing a novel cohort with favourable response to therapy with its intrinsic pathophysiological properties, yet to be explored.
