Baseline right ventricular assessment and outcomes after transcatheter tricuspid valve repair

Tricuspid regurgitation (TR) and right ventricular (RV) remodelling are closely related. Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on valvular heart disease propose adjusted reference values for RV size and function.

To determine the predictive value of the proposed RV dilatation and dysfunction thresholds in a real-world interventional cohort.

Echocardiographic thresholds were evaluated retrospectively in 651 patients, who underwent transcatheter tricuspid valve repair (TTVr) at two tertiary centres.

The primary endpoint was 2-year survival [Kaplan–Meier estimate: 78.6% (74.9–81.9)]. RV strain was the most frequent marker of dysfunction at baseline [free walls strain (FWS) <23% in 80.3%, global longitudinal strain (GLS) <21% in 88.4%]. Proposed cut-offs for RV basal (>24 mm/m²), mid (>21 mm/m²), and tricuspid annular (TA) diameters (>21 mm/m²) were associated with survival (P = .04, <.01, and <.01). Tricuspid annular plane systolic excursion <17 mm was not (P = .24), whereas tissue doppler imaging s′ <10 cm/s and FAC ≤35% were associated with survival (P = .04; .01). Severe RV dysfunction (FWS <11% or GLS <9%) was associated with survival (P < .01; .02). In multivariable analysis, TA >21 mm/m² [hazard ratio (HR) 2.85 (1.41–5.76); P < .01] and FWS <11% [HR 1.91 (1.07–3.38); P = .03] independently predicted survival. Mortality risk increased for each additional pathological parameter [HR per parameter 1.33 (1.14–1.57); P < .01]. After effective TR reduction (residual TR ≤I; n = 341, 52%), no RV cut-off remained associated with survival.

TTVr is often performed at an advanced disease stage, and adverse RV remodelling is strongly associated with survival. Nevertheless, effective TR reduction attenuated this prognostic value.