https://doi.org/10.1007/s00392-025-02625-4
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Charité - Universitätsmedizin Berlin CC11: Med. Klinik m. S. Kardiologie und Angiologie Berlin, Deutschland; 3Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland; 4Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland
Objective
This study aims to analyze the impact of pulmonary hypertension (PH) on the outcome after transcatheter tricuspid valve intervention (TTVI) and to analyze right ventricular (RV) contraction pattern in the presence of significant afterload due to PH.
Background
Right heart catheter (RHC) is recommended in patients with ≥severe tricuspid regurgitation (TR) prior to TTVI. PH is common in TR-patients yet the relationship between TR- and PH-severity and its impact on the outcome after TTVI has not been fully characterized. Furthermore, RV contraction pattern with significant afterload might be different from the contraction without relevant PH.
Methods and results
This study included 150 patients (mean age 77±7; 66% female) from three centers who received RHC and cardiac CT for analysis of valvular heart disease prior TTVI. On CT, right ventricular volumes, function and tricuspid annular plane was measured during the cardiac cycle using an AI-based software (Laralab, Munich). PA pressure was measured invasively during RHC. From 127 patients undergoing TTVI, 99 (78%) received transcatheter annuloplasty and 28 (22%) edge-to-edge-repair. The occurrence of the clinical endpoint (re-hospitalization and death) was investigated during a median follow-up of 162 (IQR 66-364) days.
Patients with a mean pulmonary artery pressure (mPAP) >30 mmHg carried a higher risk for the primary endpoint compared to patients with a mPAP <30mmHg [HR 2.611 (1.260-5.411); P<0.010].
Patients with mPAP>30 mmHg had higher baseline NtproBNP levels (P<0.01) and were more symptomatic according to NYHA functional class (P=0.012) but TR at baseline and CT-derived right ventricular function were not different (P>0.05).
Angulation change of the tricuspid annular plane during the cardiac cycle was significantly reduced in patients with mPAP >30mmHg and angulation change >10 degree exhibited a specificity of 89.1% to rule out RHC-measured mPAP >30mmHg (P<0.001).
Conclusions
In patients with severe tricuspid regurgitation, baseline mPAP had a significant impact on the primary endpoint after TTVI. Reduced angulation change of the annular plane might be used as a CT-based, non-invasive indicator for relevant PH.