Selecting the right patients for tricuspid transcatheter edge-to-edge repair (T-TEER) remains a major challenge. A new analysis of the TRI-FR trial, presented at the European Society of Cardiology (ESC) Congress 2025, suggests invasive hemodynamic markers could help refine selection strategies.

The study analyzed 209 patients who underwent right heart catheterization before being randomized to guideline-directed medical therapy alone or therapy plus T-TEER. The primary outcome was clinical response at one year, defined by freedom from major events and improvement in functional status.

In the medical therapy alone group, pulmonary artery pulsatility index and cardiac output showed modest predictive value (AUC = 0.696). Among patients receiving T-TEER, cardiac output and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio moderately predicted one-year improvement (AUC = 0.730). However, none of the markers correlated significantly with quality-of-life or exercise capacity scores.

The findings indicate that invasive hemodynamic measures—particularly cardiac output and tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio—may provide incremental value in identifying patients most likely to benefit from T-TEER. Researchers emphasize these markers should be combined with clinical and imaging criteria to optimize decision-making.