https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland; 2Universitätsklinikum Giessen und Marburg GmbH Klinik für Kardiologie, Angiologie und internistische Intensivmedizin Marburg, Deutschland; 3Universitätsmedizin Greifswald Klinik und Poliklinik für Innere Medizin B Greifswald, Deutschland; 4Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; 5Klinikum Osnabrück Medizinische Klinik I Osnabrück, Deutschland; 6RHÖN-KLINIKUM AG Campus Bad Neustadt Kardiologie Bad Neustadt a. d. Saale, Deutschland; 7RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie II / Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland; 8RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie I - Interventionelle Kardiologie und kardiale Bildgebung Bad Neustadt a. d. Saale, Deutschland
Transcatheter Edge-to-Edge Tricuspid Valve Repair (T-TEER) emerged as a safe and efficacy treatment modality in patients suffering from high-grade tricuspid valve regurgitation (TR) despite optical medical treatment. Right ventricular dysfunction (RVD) was found to adversely affect long-term survival of patients suffering from high-grade TR. In the course of T-TEER, recovery of RVD has already been observed, but the determinants of RVD recovery have not been investigated to date.
Methods:
In this multicenter observational cohort study, all patients from four cardiac centers were examined that were scheduled for T-TEER intervention between 2021-2023. Patients were divided according to concomitant RVD at time of T-TEER. RVD was defined in case of a restricted tricuspid annular plane systolic excursion (TAPSE) <17mm or a restricted right ventricular fractional area change (RV-FAC) <35%. Primary endpoint of the study was recovery of RVD, which was defined as restoration of TAPSE and RV-FAC to normal values at time of follow-up three months after T-TEER. Independent predictors of RVD recovery were identified by univariable logistic regression analysis.
Results:
A total of 105 patients during the observation period was included for further analysis. Concomitant RVD was present in 43.8% (46/105) of cases at baseline. Patients with RVD exhibited significantly higher NTproBNP levels, higher rates of ventricular functional TR etiology and a higher risk of mortality predicted by TRISCORE than patients without RVD, as illustrated in Table 1. RVD recovery was particularly evident in the case of mild RVD resulting in a TAPSE of 14-17mm (odds ratio [OR] 6.4, 95% confidence interval [CI] 1.9-14, p=0.004). Furthermore, successful reduction of TR to mild residual severity was associated with RVD recovery (OR 4.5, 95% CI 1.3-12, p=0.01). Concomitant atrial fibrillation (AF) at time of T-TEER was on the contrary associated with persistence of RVD (OR 0.1, 95%-CI 0.001-0.8, p=0.01). The independent predictors of RVD recovery were outlined in Table 2.
Conclusion:
RVD was present in 43.8% (46/105) of current “real-world” T-TEER patients. Recovery of RVD was particularly evident in patients at an early stage of mild RVD severity, where TR was successfully reduced to mild severity. Early identification and treatment of patients suffering from high-grade TR represents a key factor for improving treatment outcomes.
Table 1: Clinical characteristics of patients with vs. without concomitant RVD undergoing T-TEER intervention
| Variable | Overall cohort (n=105) | No RV-dysfunction (n=59) | RV-dysfunction (n=46) | p-value | |||
| Persistence of RV-dysfunction after T-TEER (n=24) | Recovery of RV-dysfunction after T-TEER (n=22) | p-value | |||||
| Age (years) | 81± 5.5 | 81 ± 5 | 81 ± 7 | 81 ± 4 | 0.9 | 0.9 | |
| Male sex | 41.9% (44) | 40.7% (24) | 50% (12) | 36.4% (8) | 0.8 | 0.4 | |
| TRI-SCORE (%)* | 8 ± 9 | 5 ± 2 | 14 ± 0 | 14 ± 0 | <0.001 | 0.5 | |
| NYHA III NYHA IV | 84.8% (89) 3.8% (4) | 84.7% (50) 1.7% (1) | 75% (18) 12.5% (3) |
| 0.4 | 0.2 | |
| Atrial fibrillation | 96.2% (101) | 93.2% (55) | 100% (24) | 100% (22) | 0.1 | 1 | |
| NTproBNP (pg/mL)* | 2619 ± 2647 | 2095 ± 2024 | 2974 ± 9579 | 2966 ± 2739 | 0.006 | 0.6 | |
Table 2: Independent predictors of RVD recovery after T-TEER in univariable logistic regression analysis
| Variable | Odds Ratio | 95%-Confidence interval | p-value |
| Mild RVD severity (TAPSE 14-17mm) | 6.4 | 1.9-14 | 0.004 |
| Mild residual TR after T-TEER | 4.5 | 1.3-12 | 0.01 |
| Atrial fibrillation at time of T-TEER | 0.1 | 0.001-0.8 | 0.01 |