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

JACC Cardiovasc Interv. 2020 May 25;13(10):1251-1261. doi: 10.1016/j.jcin.2020.02.028. Epub 2020 Apr 29.

Abstract

Objectives: 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.

Background: 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.

Methods: 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.

Results: 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). Final New York Heart Association functional class did not differ among TAPSE and sPAP quartiles, even when both low TAPSE and high sPAP were present. Rates of 1-year survival and survival free from hospitalization for heart failure were 83.9% and 78.7%, respectively, without significant differences according to baseline echocardiographic RV characteristics (TAPSE, fractional area change, and end-diastolic area) and sPAP (p > 0.05 for all).

Conclusions: 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.

Keywords: edge-to-edge repair; outcome; pulmonary artery pressure; right ventricular function; tricuspid regurgitation.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arterial Pressure*
  • Cardiac Catheterization* / adverse effects
  • Disease Progression
  • Echocardiography*
  • Europe
  • Female
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • North America
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Artery / diagnostic imaging*
  • Pulmonary Artery / physiopathology
  • Recovery of Function
  • Registries
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Tricuspid Valve Insufficiency / complications
  • Tricuspid Valve Insufficiency / diagnostic imaging
  • Tricuspid Valve Insufficiency / physiopathology
  • Tricuspid Valve Insufficiency / therapy*
  • Ventricular Function, Right*
  • Ventricular Pressure*

Grants and funding