Echocardiographic outcomes after transcatheter edge-to-edge repair in patients with isolated tricuspid regurgitation: the Tri.Fr Trial

Abstract Background The relationship between tricuspid regurgitation (TR) reduction after transcatheter edge-to-edge repair (T-TEER), changes in right heart function and outcomes are scarce. Purpose To explore the relationship between reverse remodeling and subsequent outcomes and the associsation between T-TEER, residual TR and outcomes. Methods Changes in echocardiographic parameters from baseline to 1-year, overall and according to TR reduction, were evaluated by a centralized echocardiographic corelab among patients included in the Tri.fr trial. Results 300 patients (78±5 years-old, 53.7% women) were enrolled; 152 patients were allocated to the T-TEER + GDMT group and 148 to the GDMT group. Patients in the T-TEER + GDMT group demonstrated a significant decrease in most of parameters of RV function, whereas those in the GDMT group exhibited no significant changes in RV metrics at 1-year. A stepwise improvement in the clinical composite score was observed with each additional grade of TR reduction. The positive effect of T-TEER on the composite clinical score was observed irrespective of baseline RA volume but only in patients with normal RV-PA coupling (defined by a TAPSE/SPAP ratio ≥0.40) (Figure 1). At 1-year, patients with an improved clinical composite score had a lower RAVi compared to those whose clinical score remained unchanged or worsened (112 [78.0; 146] vs. 141 [107; 173]ml/m², p=0.004). Conclusion Although T-TEER can decrease TR severity, its impact on conventional RV function parameters and RV-PA coupling remains limited. RV functional recovery has a smaller influence on clinical outcomes at 1-year compared to achieving optimal reduction in TR severity (Figure 2).