Right Ventricular Remodeling following Tricuspid Transcatheter Edge-to-Edge Repair: the Impact of Loading Conditions

Sara Bombace (Mainz)1, S. Rosch (Leipzig)2, A. Schöber (Leipzig)2, M. von Roeder (Leipzig)2, F. Schlotter (Leipzig)2, K.-P. Rommel (Leipzig)2, M. Gutberlet (Leipzig)3, A. Sannino (Napoli)4, H. Thiele (Leipzig)2, P. Lurz (Mainz)1, K.-P. Kresoja (Leipzig)2

1Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 3Herzzentrum Leipzig - Universität Leipzig Diagnostische und Interventionelle Radiologie Leipzig, Deutschland; 4Federico II University Division of Cardiology Napoli, Italien


The impact of tricuspid transcatheter edge-to-edge repair (T-TEER) on right ventricular (RV) remodeling is poorly understood. 
This study aimed to investigate the response of RV ejection fraction (RVEF) to T-TEER.
Patients with significant tricuspid regurgitation (TR) who underwent T-TEER and cardiac magnetic resonance (CMR) imaging were included. Post-intervention CMR imaging was performed 1 to 3 months after the procedure. The primary outcome was a composite of all-cause mortality or heart failure hospitalization. 
The study included 69 patients (median age 78 years; 54% females). Patients were categorized into three groups based on their RVEF changes: group 1 (46% of patients) with decreased RVEF, group 2 (39%) with stable RVEF, and group 3 (15%) with increased RVEF. Groups 1 and 2 showed significant reduction in TR, whereas group 3 exhibited worsening TR at follow-up. The change in RVEF after T-TEER was primarily driven by a mismatch between contractility and afterload. In group 1, afterload increased over contractility leading to decreased RVEF, while a decrease of afterload at stable contractility resulted in increased RVEF in group 3. Patients with stable RVEF showed a trend of increase in both contractility and afterload, leading to preserved coupling. During a median follow-up of 1016 days, patients in group 3 had the worst outcome, while patients in group 2 had the lowest event rates (log rank p=0.004). 
The response of the RV to T-TEER is heterogeneous, mostly influenced by the progression of TR, baseline RV function, RV-vascular interaction, and loading conditions. 
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