Relationship Between Diuretic Dose and Outcome Following Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation.

BACKGROUND

Severe tricuspid regurgitation (TR) leads to right heart volume overload and failure. Diuretic treatment is a cornerstone of medical therapy, being so far the only option in inoperable patients. Transcatheter tricuspid valve repair (TTVr) has become a viable treatment for these patients. In this study we evaluated the association between baseline loop diuretic dose and clinical outcomes after TTVr in patients with severe symptomatic TR.

METHODS

In this retrospective, single-center study, symptomatic patients with severe TR treated between 2017 and 2022 with TTVr were analyzed for the combined endpoint of heart failure hospitalization (HFH) or death at 1-year follow-up, depending on loop diuretic dose.

RESULTS

For the 225 patients (median age 80 years, 67% women) analyzed, the receiver-operating characteristic curve revealed an optimal cutoff of 95-mg furosemide-equivalent, stratifying into high-diuretic-dose (HDD) and low-diuretic-dose (LDD) groups. Intraprocedural success according to Tricuspid Valve Academic Research Consortium criteria was poorer in HDD patients (46% vs 68%, P = 0.002), as were outcomes (1-year mortality: 44% vs 11%, P < 0.001; HFH: 22% vs 10%, P < 0.001). HDD was independently associated with the combined endpoint (hazard ratio 2.498, 95% confidence interval 1.537-4.058, P < 0.001). New York Heart Association classification improved by 1 class or more in 68% of patients. Overall, the median diuretic dose at follow-up (median 388 days, interquartile range 362-537 days) remained stable.

CONCLUSIONS

Patients with HDD undergoing TTVr had worse procedural and clinical outcomes. However, they experienced symptom relief without diuretic escalation. Diuretic increases in patients with severe TR should be closely monitored and may indicate a need for prompt TTVr evaluation. This may prevent diuretic-related side effects and improve outcomes.