Echocardiographic Outcomes After Transcatheter Edge-to-Edge Repair in Patients With Isolated Tricuspid Regurgitation: The Tri.Fr Trial.

BACKGROUND

The relationships among tricuspid regurgitation (TR) reduction after tricuspid transcatheter edge-to-edge repair (T-TEER), changes in right-sided heart function, and outcomes are poorly explored.

OBJECTIVES

This study aims to explore the relationship between functional remodeling and subsequent outcomes and the associations among T-TEER, residual TR, and outcomes.

METHODS

Changes in echocardiographic parameters from baseline to 1 year, overall and according to TR reduction were evaluated by a centralized echocardiographic core laboratory in patients included in the Tri.Fr (Evaluation of Tricuspid Valve Percutaneous Repair System in the Treatment of Severe Secondary Tricuspid Disorders) trial.

RESULTS

A total of 300 patients (aged 78 ± 5 years; 53.7% women) were enrolled; 152 patients were allocated to the T-TEER + guideline-directed medical therapy (GDMT) group, and 148 were allocated to the GDMT group. Patients in the T-TEER + GDMT group demonstrated a significant decrease in most of parameters of right ventricular (RV) function, whereas patients in the GDMT group exhibited no significant changes in RV metrics at 1 year. The clinical composite score improved progressively with each successive grade of TR reduction. The positive effect of T-TEER on the composite clinical score was observed irrespective of baseline right atrial volume but only in patients with normal RV-pulmonary artery coupling (defined by a tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio ≥0.40). At 1 year, patients with an improved clinical composite score had a lower right atrial volume index compared with patients whose clinical score remained unchanged or worsened (median 112 mL/m2 [Q1-Q3: 78.0-146 mL/m2] vs median 141 mL/m2 [Q1-Q3: 107-173 mL/m2]; P = 0.004).

CONCLUSIONS

Although T-TEER can decrease TR severity, its impact on conventional RV function parameters and RV-pulmonary artery coupling remains limited. RV functional recovery has a smaller influence on clinical outcomes at 1 year compared with achieving optimal reduction in TR severity. (Evaluation of Tricuspid Valve Percutaneous Repair System in the Treatment of Severe Secondary Tricuspid Disorders [Tri.Fr]; NCT04646811).