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Comparison of different phenotypes of postcapillary pulmonary hypertension in patients undergoing transcatheter edge-to-edge tricuspid valve repair

https://doi.org/10.1007/s00392-025-02625-4

Rico Osteresch (Bremen)1, K. Diehl (Bremen)1, U. Hanses (Bremen)1, S. Alo (Bremen)1, H. Kerniss (Bremen)1, A. Fach (Bremen)1, J. Schmucker (Bremen)1, S. Rühle (Bremen)1, C. Frerker (Lübeck)2, I. Eitel (Lübeck)2, H. Wienbergen (Bremen)1, R. Hambrecht (Bremen)1

1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland

 

Background: Postcapillary pulmonary hypertension (pc-PH) is common in patients with severe tricuspid regurgitation (TR). However, the influence of different phenotypes of pc-PH on outcome is unclear.

Objective: To assess differences in outcome of isolated pc-PH (Ipc-PH) compared to combined precapillary and postcapillary pulmonary hypertension (Cpc-PH) in patients undergoing transcatheter edge-to-edge tricuspid valve repair (T-TEER) for severe TR.

Methods: Consecutive patients with severe TR and pc-PH (mean pulmonary artery pressure > 20 mmHg and pulmonary artery wedge pressure > 15 mmHg) who underwent T-TEER were included and followed prospectively. Patients were classified as having Ipc-PH (pulmonary vascular resistance (PVR) ≤ 2 Wood units), Cpc-PH (PVR > 2 Wood units) and Cpc-PH with severe precapillary component (PVR ≥ 4.25 Wood units). Primary outcome was all-cause mortality during a mean follow-up period of 12 ± 9 months.

Results: 120 patients were enrolled (mean age 81.6 ± 5.5 years, 52.0 % female). 55 patients (45.8 %) had Ipc-PH, 46 patients (38.3 %) had Cpc-PH, and 19 patients (15.8 %) had Cpc-PH with a severe precapillary component. At long-term follow-up, a significantly higher rate of all-cause mortality was observed in patients with Cpc-PH with a severe precapillary component (61.0 % vs. 28.0 % vs. 24.0 %; log-rank p = 0.031). In Cox regression analysis invasively derived right ventricular cardiac power index (RVCPI) was a strong predictor for all-cause mortality (hazard ratio (HR) 4.2; 95 % confidence interval (CI) 1.2 to 14.4; p = 0.021) whereas PVR was not (HR 1.03; 95 % CI 0.87 to 1.21; p = 0.7)

Conclusions: In patients undergoing T-TEER Cpc-PH with a severe precapillary component is associated with worse outcome. RVCPI but not PVR is a strong predictor for all-cause mortality in this cohort of patients. Therefore, classification of pc-PH by right heart catheterization could improve risk assessment of patients undergoing T-TEER.

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