Impact of Tricuspid Regurgitation on Clinical Outcomes Following M-TEER for Primary Mitral Regurgitation: Results from the PRIME-MR Registry

Clin Res Cardiol (2026). DOI 10.1007/s00392-026-02870-1
S. Ludwig (Hamburg)¹, A. Scotti (New York)², B. Köll (Hamburg)¹, D. Feldman (New York)³, A. Araujo Adams (New York)⁴, D. Patel (Los Angeles)⁵, D. Samim (Bern)⁶, C. Giannini (Pisa)⁷, J. Dreyfus (Saint-Denis)⁸, J.-M. Paradis (Quebec)⁹, Y. Bohbot (Amiens)¹⁰, A. Bernard (Tours)¹¹, A. Quagliana (Kopenhagen)¹², Y. Lavie-Badie (Toulouse)¹³, M. Keßler (Ulm)¹⁴, O. Chehab (London)¹⁵, S. Redwood (London)¹⁵, E. Lubos (Hamburg)¹⁶, O. De Backer (Copenhagen)¹⁷, M. Metra (Brescia)¹⁸, M. Weber (Bonn)¹⁹, T. K. Rudolph (Bad Oeynhausen)²⁰, C. Iliadis (Köln)²¹, F. Praz (Bern)²², M. Gercek (Bad Oeynhausen)²⁰, E. Xhepa (München)²³, G. Nickenig (Bonn)¹⁹, R. Makkar (Los Angeles)²⁴, J. Hausleiter (München)²⁵, E. Donal (Rennes)²⁶, J. Granada (New York)²⁷, T. Modine (Bordeaux)²⁸, A. Coisne (Lille)²⁹, A. Latib (Milano)³⁰, D. Kalbacher (Hamburg)^31
1Universitäres Herz- und Gefäßzentrum Klinik für Kardiologie Hamburg, Deutschland; ²Montefiore Medical Center Interventional Cardiology New York, USA; ³Montefiore Medical Center Cardiology New York, USA; ⁴Montefiore Medical Center Cardiology New York, Deutschland; ⁵Cedards Sinai Medical Center Cardiology Los Angeles, USA; ⁶Inselspital Bern Kardiologie Bern, Schweiz; ⁷Azienda Ospedaliero-Universitaria Pisana Pisa, Italien; ⁸Centre Cardiologique du Nord Saint-Denis, Frankreich; ⁹IUCPQ Quebec, Kanada; ¹⁰CHU Amiens Amiens, Frankreich; ¹¹Chru Hospitals Of Tours Tours, Frankreich; ¹²Rigshospitalet Kopenhagen, Dänemark; ¹³CHU de Toulouse Toulouse, Frankreich; ¹⁴Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; ¹⁵St. Thomas' Hospital Department of Cardiology London, Großbritannien; ¹⁶Katholisches Marienkrankenhaus gGmbH Kardiologie und Angiologie Hamburg, Deutschland; ¹⁷Rigshospitalet Copenhagen Cardiology Copenhagen, Dänemark; ¹⁸University of Brescia Cardiology, Department of Medical and Surgical Specialties Brescia, Italien; ¹⁹Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; ²⁰Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ²¹Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; ²²Inselspital - Universitätsspital Bern Universitätsklinik für Kardiologie Bern, Schweiz; ²³Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; ²⁴Cedars-Sinai Medical Center Los Angeles, USA; ²⁵LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; ²⁶CHU Rennes Departement of Cardiology Rennes, Frankreich; ²⁷Cardiovascular Research Foundation New York, USA; ²⁸Centre Hospitalier Universitaire Bordeaux Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle Bordeaux, Frankreich; ²⁹Heart Valve Clinic, CHU Lille Department of Clinical Physiology and Echocardiography Lille, Frankreich; ³⁰San Raffaele Hospital Interventional Cardiology Milano, Italien; ³¹Universitäres Herz- und Gefäßzentrum Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland

Background: The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation (PMR).

Aims: This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with PMR undergoing mitral transcatheter edge-to-edge repair (M-TEER).

Methods: The PRIME-MR registry included 3,083 patients with severe PMR undergoing M-TEER in 2008-2022 at 25 international sites. Only patients with successful M-TEER procedures (MR≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) vs TR≥Severe (TR≥Sev). The primary endpoint was 2-year all-cause mortality.

Results: A total of 2,155 patients were analyzed: TR≥Sev (n=421 [20%]) vs. TR≤Mod (n=1,734 [80%]). Patients with TR≥Sev were more likely to be NYHA III/IV (P=0.003), have shorter 6-minute walk distance (P<0.001), higher NT-proBNP (P<0.001), higher creatinine (P<0.001), higher pulmonary artery pressures (P<0.001), atrial fibrillation (P<0.001), and more diuretics (P<0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% vs. 19.6%, P_log-rank<0.0001) and Heart Failure hospitalization (21.1% vs. 16.8%, P_Gray=0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (Adj-HR 1.77 [1.22-2.58], P=0.0029). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% vs. 19.9%, P_log-rank=0.0037) than TR≤Mod.

Conclusions: In the PRIME-MR Registry, one of every five patients with PMR had severe TR at baseline. TR Severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2-years.