https://doi.org/10.1007/s00392-025-02737-x
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Inselspital - Universitätsspital Bern Universitätsklinik für Kardiologie Bern, Schweiz
Background:
While most patients with significant tricuspid regurgitation (TR) experience exercise intolerance and fatigue, only a subset present with peripheral edema. This study aimed to determine whether peripheral edema identifies a distinct clinical phenotype and to assess its prognostic implications following transcatheter tricuspid valve (TTV) repair.
Methods:
In this retrospective single-center study, 254 consecutive patients who underwent TTV repair for symptomatic TR between October 2018 and April 2023 were analyzed. Patients were stratified based on the presence of peripheral edema at initial presentation: those who presented with edema (edema-positive; n=154, 60.6%) and those without edema (edema-negative; n=100, 39.4%). Baseline characteristics, hemodynamic parameters, and clinical outcomes were compared. Cox proportional hazards regression was used to identify predictors of all-cause mortality.
Results:
The cohort had a mean age of 78.9 ± 7.3 years, with 59% female patients and a mean EuroSCORE II of 7.26 ± 8.0. Compared to the edema-negative group, edema-positive patients were older (79.7 ± 6.9 vs. 77.7 ± 7.9 years, p=0.038), had higher BMI (26.2 ± 5 vs. 24.8 ± 3.9 kg/m2, p=0.01), and exhibited a higher prevalence of atrial fibrillation (92% vs. 80%, p=0.004) and diabetes mellitus (31% vs. 11%, p<0.001). They also demonstrated worse functional status (6-minute walk distance: 215 ± 97 m vs. 255 ± 100 m, p=0.04) and evidence of end-organ dysfunction, including lower hemoglobin (11.9 ± 2.4 vs. 12.7 ± 1.7 g/dL, p=0.03), estimated glomerular filtration rate (47 ± 19 vs. 53 ± 20 mL/min, p=0.02), and serum albumin (3.3 ± 0.9 vs. 3.8 ± 0.6 g/dL, p=0.003). Hemodynamic assessment revealed significantly higher mean pulmonary artery (31 ± 9 vs. 26 ± 7 mmHg, p<0.001), pulmonary capillary wedge (21 ± 7 vs. 16 ± 7 mmHg, p<0.001), and right atrial pressures (14 ± 6 vs. 11 ± 6 mmHg, p<0.001) in the edema-positive group, despite similar cardiac index, pulmonary vascular resistance, left and right ventricular fraction parameters, TR severity, and daily loop diuretic dose. On multivariable Cox regression analysis, peripheral edema emerged as an independent predictor of all-cause mortality post-TTV repair (HR 8.7; 95% CI 1.1–70.0; p=0.04). Kaplan-Meier analysis demonstrated significantly reduced survival in the edema-positive group during a mean follow-up of 340 days (log-rank p<0.001).
Conclusions:
Peripheral edema in patients with significant TR delineates a high-risk clinical phenotype marked by advanced age, greater comorbidity burden, impaired functional capacity, and adverse hemodynamic profiles. Its association with worse post-TTV repair survival highlights the need for heightened clinical attention and potentially tailored management strategies in this vulnerable subgroup.