Weckbach Ludwig T, Stolz Lukas, Doldi Philipp M, Glaser Hannah, Ennin Cecilia, Kothieringer Michael, Stocker Thomas J, Näbauer Michael, Kassar Mohammad, Bombace Sara, Kresoja Karl-Patrik, Lurz Philipp, Praz Fabien, Thiele Holger, Rudolph Volker, Massberg Steffen, Hausleiter Jörg
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
Eur J Heart Fail. 2024 Nov 26. doi: 10.1002/ejhf.3529.
Right ventricular reverse remodelling (RVRR) is linked to improved survival in patients with severe tricuspid regurgitation (TR) and right-sided heart failure who underwent interventional treatment. However, the role of residual TR on RVRR remains unclear. In this analysis the impact of residual TR on RVRR after interventional TR treatment, which was validated by two independent cohorts at four sites using echocardiography or cardiac magnetic resonance (CMR) imaging, was investigated.
Overall, 253 patients who were treated for severe TR and right-sided heart failure using different treatment modalities (tricuspid transcatheter edge-to-edge repair [T-TEER], transcatheter tricuspid valve annuloplasty, orthotopic transcatheter TV replacement [TTVR], heterotopic TTVR) were included. Three-dimensional echocardiographic and CMR-based assessment of RVRR and clinical evaluation of decongestion or exercise capacity were performed at baseline and 30 days after the procedure. Mortality was analysed at 1 year after transcatheter tricuspid valve intervention (TTVI). In patients with residual TR ≤1+ pronounced reduction of right ventricular end-diastolic and end-systolic volumes was observed. In patients with residual TR ≥2+ the effect of RVRR gradually decreased with higher residual TR reinforcing the relevance of optimal procedural results for RVRR. These findings were validated in two independent cohorts. In contrast to RVRR, residual TR ≤1+ and 2+ were associated with similar 1-year survival. RVRR was only observed after T-TEER or orthotopic TTVR, but not after heterotopic TTVR as expected. However, all three treatment modalities were accompanied by significant decongestion and functional improvement at 30-day follow-up.
In patients with severe TR and right-sided heart failure undergoing TTVI, superior procedural results were associated with more pronounced RVRR.
右心室逆向重构（RVRR）与接受介入治疗的严重三尖瓣反流（TR）和右心衰竭患者生存率的提高相关。然而，残余TR对RVRR的作用仍不明确。在本分析中，研究了残余TR对介入性TR治疗后RVRR的影响，该研究在四个地点通过两个独立队列使用超声心动图或心脏磁共振（CMR）成像进行了验证。
总体而言，纳入了253例接受不同治疗方式（三尖瓣经导管缘对缘修复术[T-TEER]、经导管三尖瓣瓣环成形术、原位经导管人工心脏瓣膜置换术[TTVR]、异位TTVR）治疗的严重TR和右心衰竭患者。在基线和术后30天进行基于三维超声心动图和CMR的RVRR评估以及充血缓解或运动能力的临床评估。在经导管三尖瓣瓣膜介入治疗（TTVI）后1年分析死亡率。在残余TR≤1+的患者中，观察到右心室舒张末期和收缩末期容积明显减少。在残余TR≥2+的患者中，RVRR的效果随着残余TR的增加而逐渐降低，这强化了最佳手术结果对RVRR的相关性。这些发现在两个独立队列中得到验证。与RVRR不同，残余TR≤1+和2+与相似的1年生存率相关。RVRR仅在T-TEER或原位TTVR后观察到，而异位TTVR后未观察到，正如预期的那样。然而，所有三种治疗方式在30天随访时均伴有显著的充血缓解和功能改善。
在接受TTVI的严重TR和右心衰竭患者中，更好的手术结果与更明显的RVRR相关。
