A study published in JACC: Cardiovascular Interventions has found that patients with severe tricuspid regurgitation (TR) who undergo transcatheter tricuspid edge-to-edge repair (T-TEER) face worse clinical outcomes if they have underlying right ventricular (RV) dysfunction or dilation.

The study analyzed data from the EuroTR registry and included patients treated with T-TEER between 2016 and 2023 across 20 heart valve centers in Europe. A total of 2,191 patients were included in the analysis. The mean age of the cohort was 78 years, and there were 53% women. RV dysfunction was defined by a tricuspid annular plane systolic excursion (TAPSE) of less than 17 mm. RV dilation was marked by an RV mid-diameter greater than 35 mm. The researchers determined them through baseline echocardiography.

TR was successfully reduced to a severity grade of ≤2+ in 80% of the patients (1,608 out of 2,001). However, multivariable analysis showed that both RV dysfunction and RV dilation were significantly associated with increased risk of death and hospitalization for heart failure. For every 1-mm decrease in TAPSE, the hazard of mortality increased by 5% (HR: 1.05; 95% CI: 1.03–1.08), while each 1-mm increase in RV mid-diameter raised mortality risk by 2% (HR: 1.02; 95% CI: 1.00–1.03).

Residual TR also played a crucial role in determining patient outcomes. Individuals with TR graded >2+ after the procedure had a 70% higher risk of death (HR: 1.70; 95% CI: 1.36–2.13). These parameters not only predicted mortality independently but also the combined outcome of death and heart failure hospitalization. Patients with both RV dysfucntion and dilation have worst outcomes.