Stolz Lukas, Kresoja Karl-Patrik, von Stein Jennifer, Fortmeier Vera, Koell Benedikt, Rottbauer Wolfgang, Kassar Mohammad, Goebel Bjoern, Denti Paolo, Achouh Paul, Rassaf Tienush, Barreiro-Perez Manuel, Boekstegers Peter, Rück Andreas, Doldi Philipp M, Novotny Julia, Zdanyte Monika, Adamo Marianna, Vincent Flavien, Schlegel Philipp, von Bardeleben Ralph Stephan, Stocker Thomas J, Weckbach Ludwig T, Wild Mirjam G, Besler Christian, Brunner Stephanie, Toggweiler Stefan, Grapsa Julia, Patterson Tiffany, Thiele Holger, Kister Tobias, Tarantini Giuseppe, Masiero Giulia, De Carlo Marco, Sticchi Alessandro, Konstandin Mathias H, Van Belle Eric, Metra Marco, Geisler Tobias, Estévez-Loureiro Rodrigo, Luedike Peter, Karam Nicole, Maisano Francesco, Lauten Philipp, Praz Fabien, Kessler Mirjam, Kalbacher Daniel, Rudolph Volker, Iliadis Christos, Lurz Philipp, Hausleiter Jörg
Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
JACC Cardiovasc Interv. 2025 Feb 10;18(3):325-336. doi: 10.1016/j.jcin.2024.10.023. Epub 2024 Oct 28.
Data regarding the association of pulmonary hypertension (PH) and outcomes in patients undergoing transcatheter tricuspid valve edge-to-edge repair (T-TEER) are scarce.
The aims of this study were: 1) to investigate the impact of PH on outcomes after T-TEER; and 2) to shed further light on the role of precapillary- and postcapillary PH in patients undergoing T-TEER for relevant tricuspid regurgitation (TR).
The study included patients from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) who underwent T-TEER for relevant TR from 2016 until 2023 with available invasive evaluation of systolic pulmonary artery pressure (sPAP) using right heart catheterization. Study endpoints were procedural TR reduction, improvement in NYHA function class, and a combined endpoint of death or heart failure hospitalization (HFH) at 2 years.
Among a total of 1,230 patients (mean age 78.6 ± 7.0 years, 51.4% women), increasing sPAP was independently associated with increasing rates of 2-year death or HFH (HR: 1.027; 95% CI: 1.003-1.052; P = 0.030; median survival follow-up 343 days [Q1-Q3: 114-645 days]). No significant survival differences were observed for patients with pre- vs postcapillary PH. Sensitivity analysis revealed an sPAP value of 46 mm Hg as the optimized threshold for the prediction of death or HFH. Being observed in 526 patients (42.8%), elevated sPAP (>46 mm Hg) was associated with more severe heart failure symptoms at baseline and follow-up. Importantly, NYHA functional class significantly improved and TR severity was significantly reduced irrespective of PH.
PH is an important outcome predictor in patients undergoing T-TEER for relevant TR. In contrast to previous studies, no significant differences were observed for patients with precapillary and postcapillary PH in terms of survival free from HFH.
关于肺动脉高压（PH）与经导管三尖瓣缘对缘修复术（T-TEER）患者预后之间关联的数据较少。
本研究的目的是：1）研究PH对T-TEER术后预后的影响；2）进一步阐明毛细血管前性和毛细血管后性PH在因相关三尖瓣反流（TR）接受T-TEER治疗的患者中的作用。
该研究纳入了来自EuroTR（欧洲三尖瓣反流经导管修复注册研究；NCT06307262）的患者，这些患者在2016年至2023年期间因相关TR接受了T-TEER治疗，并通过右心导管检查对收缩期肺动脉压（sPAP）进行了有创评估。研究终点包括手术相关TR的减少、纽约心脏协会（NYHA）功能分级的改善以及2年时死亡或心力衰竭住院（HFH）的复合终点。
在总共1230名患者（平均年龄78.6±7.0岁，51.4%为女性）中，sPAP升高与2年死亡或HFH发生率增加独立相关（风险比：1.027；95%置信区间：1.003-1.052；P = 0.030；中位生存随访343天[四分位间距：114-645天]）。毛细血管前性PH患者和毛细血管后性PH患者的生存率无显著差异。敏感性分析显示，sPAP值46 mmHg为预测死亡或HFH的最佳阈值。在526名患者（42.8%）中观察到，sPAP升高（>46 mmHg）与基线和随访时更严重的心力衰竭症状相关。重要的是，无论是否存在PH，NYHA功能分级均显著改善，TR严重程度显著降低。
PH是因相关TR接受T-TEER治疗患者的重要预后预测指标。与先前的研究不同，毛细血管前性和毛细血管后性PH患者在无HFH生存方面未观察到显著差异。
