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Impact of Left and Right Ventricular Stroke Work Indices on Mortality after Transcatheter Edge-to-Edge-Repair for Severe Tricuspid Valve Regurgitation

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

Ulrich Hanses (Bremen)1, K. Diehl (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, R. Osteresch (Bremen)1

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

 

Background: Transcatheter edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR) is an emerging treatment option for patients at high surgical risk. While both left and right ventricular stroke work indices (LVSWI and RVSWI) reflect cardiac function, their relative impact on survival following T-TEER remains underexplored.

Objective: This study aimed to assess the prognostic significance of LVSWI and RVSWI on all-cause mortality after T-TEER for severe TR.

Methods: Consecutive patients with severe TR who underwent T-TEER between August 2020 and May 2024 were included and followed prospectively. Patients were stratified into four groups based on median LVSWI (26.8 g/m-1/m²) and RVSWI (5.9 g/m-1/m²): high-LVSWI/high-RVSWI, high-LVSWI/low-RVSWI, low-LVSWI/high-RVSWI and low-LVSWI/low-RVSWI. Primary endpoint was defined as all-cause mortality during a mean follow-up period of 12 ± 9 months. LVSWI and RVSWI were calculated as: LVSWI = (mean arterial pressure – pulmonary capillary wedge pressure) × stroke volume index (SVI) × 0.0136 = g/m-1/m², and RVSWI = (mean pulmonary artery pressure – right atrial pressure) × SVI × 0.0136 = g/m-1/m². The prognostic values of LVSWI and RVSWI were evaluated using receiver operator characteristic (ROC) analysis, Kaplan-Meier survival analysis, and Cox proportional-hazards regression with covariate adjustment.

Results: The study included 144 patients (mean age 81 ± 6 years, 56% female, median logistic EuroSCORE 13% [IQR 8–23]). At long-term follow-up all-cause mortality was 37 (28%), predominantly observed in patients with low LVSWI (73% of deaths). ROC analysis revealed that LVSWI demonstrated superior discriminatory power compared to RVSWI (area under curve [AUC]: 0.68, 95% confidence interval (CI): 0.59–0.78 vs. 0.58, 95% CI: 0.47–0.68). Kaplan-Meier survival curves indicated significantly lower survival rates for patients in the low-LVSWI groups (log-rank p < 0.001). In Cox regression analysis, low LVSWI was identified as an independent predictor of all-cause mortality (hazard ratio [HR] 0.44, 95% CI: 0.27–0.71, p < 0.001), while RVSWI was not (HR 0.56, 95% CI: 0.11–2.97, p = 0.5).

Conclusions: LVSWI is a significant predictor of all-cause mortality following T-TEER for severe TR, suggesting its utility in risk stratification and patient selection. The influence of LVSWI on survival was notably greater than that of RVSWI.

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