Understanding whether clinical benefit after tricuspid transcatheter edge-to-edge repair is driven by valve improvement or right heart remodeling is essential for treatment decisions in severe secondary tricuspid regurgitation. A study in JACC: Cardiovascular Imaging evaluated these relationships using data from the Tri.Fr trial.

The study included 300 adults with a mean age of 78 ± 5 years and 53.7 percent women. A total of 152 participants were assigned to tricuspid transcatheter edge-to-edge repair plus guideline-directed medical therapy and 148 to guideline-directed medical therapy alone. A centralized echocardiographic core laboratory assessed changes in right ventricular and right atrial parameters from baseline to one year. Outcomes were analyzed according to the degree of tricuspid regurgitation reduction.

Significant reductions in most right ventricular functional parameters were observed only in the repair group. The clinical composite score improved progressively with each higher grade of tricuspid regurgitation reduction. Right atrial volume index was lower in participants who improved clinically, with a median of 112 mL per square meter compared with 141 mL per square meter in those without improvement. Benefit from repair occurred regardless of baseline right atrial volume but required preserved right ventricular to pulmonary artery coupling, defined as a tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio of at least 0.40.

The findings indicate that optimal tricuspid regurgitation reduction has a greater influence on one year outcomes than right ventricular functional recovery. A neutral interpretation is that structural remodeling has a limited role in determining early clinical benefit.