https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie und internistische Intensivmedizin Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland
Background: Tricuspid regurgitation is associated with severe impairment of quality of life and poor survival. Transcatheter-edge-to-edge-repair (TEER) has developed as the primary therapy of choice for patients at prohibitive risk for cardiac surgery. Prediction of procedural success and clinical course is crucial to identify appropriate patients and avoid futility. Right atrial volume index was found to be associated with morbidity and mortality after TEER. With this study we intended to evaluate total atrial volume index (TAVi) as an outcome predictor after TEER. Our hypothesis was that adding a parameter of left heart remodeliung (left atrial volume) may increase predictive power.
Methods: A total of 69 consecutive patients undergoing tricuspid TEER (T-TEER) between January 2022 and February 2024 were included in the analysis. The total atrial volume index (TAVi) was calculated from the sum of both atrial volumes in relation to the patient's body surface area. Due to the skewed distribution of this parameter, patients with a TAVi in the highest quartile (Q4) were compared with patients in the other three quartiles (Q1-Q3). Main composite endpoint was a combination of all-cause mortality, heart-failure hospitalization, re-intervention or cardiac surgery and a recurrence of severe tricuspid regurgitation.
Results: Of the 69 patients treated, 20 were assigned to Q4 with a mean TAVi of 182.16 ml. The other 49 patients composed the Q1-Q3 group with a mean TAVi of 99.89 ml. There was no significant difference in age, gender, comorbidities and medication between the two groups, nor were lab parameters including NT-proBNP. Both available TEER systems (n= TriClip, Abbott Medical; n= PASCAL, Edwards Lifesciences both USA) were implanted with no significant difference in either the choice of system or the number of implanted devices. The primary endpoint was reached sig. more often in the Q4 group (50 vs 20%, p=0.014). Further there were more procedure-related complications in the Q4 group: 3 patients (15%) experienced single leaflet device attachment (Q1 - Q3: 0% (0 of 49); p = 0.022). Also, postprocedurally more patients in the Q4 group had a residual TR of more than moderate grade (25 vs 11%, p = 0.02).
Conclusion: Patients with a TAVi in the highest quartile were found to reach the combined endpoint more often and had worse periprocedual outcomes. Easy to evaluate TAVi may help to identify patients at higher risk for suboptimal outcome after T-TEER. Further studies are warranted to prove this hypothesis-generating finding.