Aug 2026· European Heart Journal· Vol 2· 0 citations
TL;DR
After effective TR reduction (residual TR <I; n=341, 52%), no RV cut-off remained associated with survival, and effective TR reduction attenuated this prognostic value.
Abstract
Tricuspid regurgitation (TR) and right ventricular (RV) remodelling are closely related. Recent ESC/EACTS guidelines on valvular heart disease propose adjusted reference values for RV size and function.
To determine the predictive value of the proposed RV dilatation and dysfunction thresholds in a real-world interventional cohort.
Echocardiographic thresholds were evaluated retrospectively in 651 patients, who underwent transcatheter tricuspid valve repair (TTVr) at two tertiary centres.
The primary endpoint was 2-year survival (Kaplan–Meier estimate: 78.6% [74.9–81.9]). RV strain was the most frequent marker of dysfunction at baseline (FWS <23% in 80.3%, GLS <21% in 88.4%). Proposed cut-offs for RV basal (>24 mm/m2), mid (>21 mm/m2), and tricuspid annular (TA) diameters (>21 mm/m2) were associated with survival (p=0.04, <0.01, and <0.01). TAPSE <17 mm was not (p=0.24), whereas TDI s’ <10 cm/s and FAC ≤35% were associated with survival (p=0.04; 0.01). Severe RV dysfunction (FWS <11% or GLS <9%) was associated with survival (p<0.01; 0.02). In multivariable analysis, TA >21 mm/m2 (HR 2.85 [1.41–5.76]; p<0.01) and FWS <11% (HR 1.91 [1.07–3.38]; p=0.03) independently predicted survival. Mortality risk increased for each additional pathological parameter (HR per parameter 1.33 [1.14–1.57]; p <0.01). After effective TR reduction (residual TR <I; n=341, 52%), no RV cut-off remained associated with survival.
TTVr is often performed at an advanced disease stage, and adverse RV remodelling is strongly associated with survival. Nevertheless, effective TR reduction attenuated this prognostic value.
BACKGROUND
The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated.
OBJECTIVES
This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort.
METHODS
Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention.
RESULTS
A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint.
CONCLUSIONS
The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
X. Galloo, M. Dietz, E. Prihadi et al.· JACC Cardiovascular Imaging· 0 citations
BACKGROUND
Transcatheter edge-to-edge repair (TEER) and replacement (TTVR) have emerged as new modalities to treat patients with symptomatic significant tricuspid regurgitation. This study aimed to compare invasive hemodynamic and right ventricular (RV) changes and symptom improvement over 1 year.
METHODS
Patients who underwent TEER/TTVR at Mayo Clinic (Rochester, MN, 2017-2024) were included. Hemodynamic profiles were described before and immediately after intervention, in addition to RV enlargement/dysfunction ≥moderate at 30 days and change in symptoms over time.
RESULTS
Of 100 patients included (50 per group, median age 81 versus 80 years and female 62% versus 42%, in TTVR and TEER, respectively), all had ≥ moderate-severe symptomatic tricuspid regurgitation. Post intervention, mean right atrial pressure decreased in TEER (16 to 14 mm Hg, P<0.001), V wave decreased in both groups (to 16 mm Hg, P<0.001). RV enlargement was less prevalent in both cohorts at 30 days (60%-40% in TEER, P=0.01, and 72 to 58% in TTVR, P=0.07), yet prevalence of RV dysfunction decreased only in TEER (26 to 15%, P=0.17) as opposed to TTVR (31 to 44%, P=0.13). TTVR resulted in a higher stroke volume index and more complete tricuspid regurgitation elimination at 30 days. Both groups resulted in similar improvements in New York Heart Association class, with overall similar survival.
CONCLUSIONS
TEER was associated with a greater reduction in right atrial pressure and more favorable RV remodeling at 30 days, as opposed to TTVR, which achieved more complete and sustained elimination of tricuspid regurgitation with higher forward stroke volume.
Mohamad S. Alabdaljabar, Mohamed Elhadi, J. Thaden et al.· Journal of the American Hear...· 0 citations
3D RV-CS provides complementary prognostic information in patients undergoing ITVS and may improve preoperative risk stratification and improve risk reclassification beyond European System for Cardiac Operative Risk Evaluation II, TRI-SCORE, and Society of Thoracic Surgeons score models.
Yuan-Feng Wu, Yu Liu, F. Meng et al.· JACC: Asia· 1 citation
Background: The mid-term prognosis after transcatheter tricuspid valve replacement (TTVR) is poorly defined, and echocardiographic predictors remain uncertain. Objectives: To describe mid-term all-cause mortality, 30-day major adverse events (MAEs), and echocardiographic risk markers of TTVR. Methods: Consecutive patients undergoing TRAVEL (Transcatheter right atrial-ventricular valve replacement With LuX-Valve) at three centers were retrospectively analyzed. Firth Cox regression was applied for mortality, and Firth logistic regression was used for exploratory MAE analyses. Results: A total of 62 patients (median age 66.5 years [61.0–72.8], 83.8% female) were included. Over a mean follow-up of 46.2 months, seven deaths (11.2%) occurred, corresponding to mid-term survival of 88.8%. Within 30 days, 14 patients (22.6%) experienced MAEs, including three deaths (4.8%), major bleeding in eight (12.9%), surgical re-exploration in seven (11.3%), repeat open-heart tricuspid valve replacement in one (1.6%), and permanent pacemaker implantation in six (9.7%). TR was reduced to mild or less in 95.2% at 1 year. Conclusions: In this LuX-Valve TTVR cohort, 30-day MAEs mainly reflected perioperative or device-related complications rather than a direct signal of baseline RV dysfunction or remodeling. LuX-Valve implantation showed favorable mid-term survival and clinically meaningful procedural effectiveness; RV-centered echocardiographic markers should be considered hypothesis-generating and require validation in larger cohorts.
Xing Zhao, Hao Shi, Ying Peng et al.· Journal of Cardiovascular De...· 0 citations
BACKGROUND
Tricuspid transcatheter edge-to-edge repair (T-TEER) is an effective treatment for severe tricuspid regurgitation (TR), but predictors of outcome and clinical benefit after T-TEER remain limited.
METHODS
In 144 patients with severe symptomatic TR undergoing T-TEER, left and right ventricular stroke work indices (LVSWI, RVSWI) were calculated from invasive hemodynamics by right heart catheterization. Patients were stratified by median values (LVSWI 27 cJ/m2, RVSWI 6 cJ/m2) into four subgroups. The primary endpoint was one-year all-cause mortality.
RESULTS
After T-TEER, all-cause mortality was 28%. Outcomes differed significantly across subgroups: LVSWI high, RVSWI high: 15%, LVSWI high, RVSWI low: 15%, LVSWI low, RVSWI high: 55%, and LVSWI low, RVSWI low: 31% (Kaplan-Meier, log-rank p = 0.00027). Patients with low LVSWI but high RVSWI had the poorest survival, characterized by elevated pulmonary artery pressures, pulmonary capillary wedge pressure, and left ventricular transmural pressure. In univariate Cox regression, LVSWI below the median predicted mortality (≤ 27 cJ/m2; HR 4.73, 95% CI 2.07-10.8; p < 0.001), whereas RVSWI did not. LVSWI remained an independent predictor after adjusting in multivariate analysis (HR 0.44, 95% CI 0.27-0.71; p < 0.001).
CONCLUSION
LVSWI is a robust, independent prognostic marker after T-TEER, whereas RVSWI alone lacks predictive value. A discordant profile of low LVSWI with high RVSWI identifies a particularly high-risk subgroup with >50% mortality within one year. Incorporating stroke work indices into pre-procedural assessment may refine risk stratification and optimize management strategies in T-TEER candidates.
U. Hanses, Kathrin Diehl, Shiyar Alo et al.· Canadian Journal of Cardiolo...· 0 citations
The right ventricular contractile pattern is altered after heart transplantation (HT). This study aims to use three-dimensional echocardiography (3DE) to comprehensively assess right ventricular contractile pattern in HT patients.
In a cohort of 200 adult HT recipients, we serially assessed 3DE RV contraction patterns—including global (RVEF), longitudinal (LEF), radial (REF), and anteroposterior (AEF) ejection fractions—from the early post-operative period to 3 years. 50 HT patients were compared to matched healthy controls and open-heart surgery patients. Sex-specific reference values were derived.
RV function parameters improved within the first year (all
P
< 0.05), then stabilized. At 1 year, HT recipients exhibited a distinct 3D contraction pattern compared to controls: attenuated longitudinal and anteroposterior function (LEF: 18.2% vs. 28.6%; AEF: 23.8% vs. 25.4%;
P
< 0.05) with compensatory enhanced radial contraction (REF: 29.8% vs. 24.6%;
P
< 0.05). Established reference ranges confirmed this phenotype. Cardiopulmonary bypass time were key determinants of this pattern.
HT recipients develop a unique, stabilized RV contraction pattern by one year, characterized by a shift from longitudinal to radial dominance.
Yu-Ji Xie, Wei Sun, Lin-Yue Zhang et al.· Frontiers in Cardiovascular...· 0 citations
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