Value of Echocardiographic Right Ventricular and Pulmonary Pressure Assessment in Predicting Transcatheter Tricuspid Repair Outcome

• Published in: JACC. Cardiovascular interventions 2020-05, Vol.13 (10), p.1251-1261
• Main Authors: Karam, Nicole, Mehr, Michael, Taramasso, Maurizio, Besler, Christian, Ruf, Tobias, Connelly, Kim A., Weber, Marcel, Yzeiraj, Ermela, Schiavi, Davide, Mangieri, Antonio, Vaskelyte, Laura, Alessandrini, Hannes, Deuschl, Florian, Brugger, Nicolas, Ahmad, Hasan, Ho, Edwin, Biasco, Luigi, Orban, Mathias, Deseive, Simon, Braun, Daniel, Gavazzoni, Mara, Rommel, Karl-Philipp, Pozzoli, Alberto, Frerker, Christian, Näbauer, Michael, Massberg, Steffen, Pedrazzini, Giovanni, Tang, Gilbert H.L., Windecker, Stephan, Schäfer, Ulrich, Kuck, Karl-Heinz, Sievert, Horst, Denti, Paolo, Latib, Azeem, Schofer, Joachim, Nickenig, Georg, Fam, Neil, von Bardeleben, Stephan, Lurz, Philipp, Maisano, Francesco, Hausleiter, Jörg
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arterial Pressure; Cardiac Catheterization - adverse effects; Disease Progression; Echocardiography; edge-to-edge repair; Europe; Female; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Male; Middle Aged; North America; outcome; Predictive Value of Tests; Prospective Studies; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; pulmonary artery pressure; Recovery of Function; Registries; right ventricular function; Severity of Illness Index; Time Factors; Treatment Outcome; tricuspid regurgitation; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - therapy; Ventricular Function, Right; Ventricular Pressure
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2020.02.028

The aim of this study was to assess the value of echocardiographic right ventricular (RV) and systolic pulmonary artery pressure (sPAP) assessment in predicting transcatheter tricuspid edge-to-edge valve repair (TTVR) outcome. RV dysfunction and pulmonary hypertension are associated with poor prognosis and are systematically sought during tricuspid regurgitation evaluation. The value of echocardiographic assessment in predicting TTVR outcome is unknown. Data were taken from the TriValve (Transcatheter Tricuspid Valve Therapies) registry, which includes patients undergoing TTVR at 14 European and North American centers. The primary outcome was 1-year survival free from hospitalization for heart failure, and secondary outcomes were 1-year survival and absence of hospital admission for heart failure at 1 year. Overall, 249 patients underwent TTVR between June 2015 and 2018 (mean tricuspid annular plane systolic excursion [TAPSE] 15.8 ± 15.3 mm, mean sPAP 43.6 ± 16.0 mm Hg). Tricuspid regurgitation grade ≥3+ was found in 96.8% of patients at baseline and 29.4% at final follow-up; 95.6% were in New York Heart Association functional class III or IV initially, compared with 34.3% at follow-up (p  0.05 for all). TTVR provides clinical improvement, with 1-year survival free from hospital readmission >75% in patients with severe tricuspid regurgitation. Conventional echocardiographic parameters used to assess RV function and sPAP did not predict clinical outcome after TTVR. [Display omitted]