https://doi.org/10.1007/s00392-025-02625-4
1Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; 2Helios-Klinikum Erfurt Kardiologie & Internistische Intensivmedizin Erfurt, Deutschland
Background
Severe tricuspid regurgitation (TR III-V) is receiving increasing attention due to new interventional approaches. TR is almost exclusively of functional origin, resulting from right ventricular (RV) and annulus dilatation and indicative of progressive right-sided cardiac disease. The efficacy of transcatheter tricuspid valve repair (TTVR) is still a matter of debate and clinical impact likely linked to postinterventional RV remodelling.
Objective
This MRI study aims to evaluate the impact of TTVR for functional tricuspid regurgitation (FTR) on RV remodeling post-treatment.
Methods
This monocentric, non-randomized prospective study included 28 patients (18 females; 76±9years ) with severe FTR undergoing TTVR therapy. Patients underwent Cardiac MRI (magnetic resonance imaging) before and within three month after TTVR including measurement of right ventricular (RV) parameters. Statistical analysis was performed to identify mortality-associated risk factors and factors associated with RV remodeling.
Results
At 30-day follow-up, the overall mortality rate was 0%. As depicted in figure 1 A-D, cardiac MR-imaging reveals a significant reduction in the regurgitant volume (-16±4 ml, P=0.0012). Additionally, there was a reduction in RV end-diastolic volume (-30±19 ml, P=0.1726). Although the reduction in overall RV volumes wasn‘t statistically significant, a subgroup (18 Patients) analysis revealed a significant reduction (-35±9 ml/m², P=0.0007) in cases where the RV is initially dilated (right ventricular end-diastolic volume index >100 ml/m²). Another subgroup (22 Patients) wich had a significant reduction in regurgitant volume after TTVR was analyzed, showing also a statistically significant reduction in the RV volume (- 43±6 ml, P=0,001). The right ventricular ejection fraction remains unchanged before versus after the procedure (-0.03±0.02, P=0.1480).
Conclusion
Findings indicate the safety of TTVR with regard to 30-day mortality. Cardiac MRI demonstrates the positive of TTVR on RV remodelling by a reduction of enddiastolic and endsystolic RV volumes within 3 month after TTVR, suggesting a potential benefit of this therapy. Limitations include the small sample size as well as the lack of functional clinical data.