Prognostic Value of NYHA Functional Class in Tricuspid Valve Transcatheter Edge-to-Edge Repair: Insights From EuroTR.

DOI
Publisher DOI
PubMed ID
42663375
Abstract
BACKGROUND: In patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR), NYHA functional class guides assessment, but real-world data on its prognostic value and determinants of symptomatic response remain limited.

OBJECTIVES: The objective of the study was to assess the prognostic value of baseline NYHA functional class and identify correlates of NYHA functional class trajectories after T-TEER.

METHODS: A total of 3,467 patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) undergoing T-TEER were analyzed. Baseline NYHA functional class was related to survival and heart failure hospitalization. In patients with paired NYHA functional class assessments, correlates of improvement and worsening were evaluated using prespecified multivariable logistic regression.

RESULTS: Among 3,424 patients with available baseline NYHA functional class (43 excluded [1.2%]), the median follow-up was 460 days (IQR: 146-856 days). Kaplan-Meier curves demonstrated separation by baseline NYHA functional class for overall and heart failure hospitalization-free survival (both P < 0.001). Two-year mortality was 28.4% (619/3,424; 95% CI: 26.4%-30.4%). In the complete-case Cox cohort (n = 2,185; 63.8%), higher baseline NYHA functional class was associated with 2-year mortality (HR: 1.8 per 1-class increase; 95% CI: 1.5-2.1; P < 0.001). In 1,974 of 3,424 patients (57.7%) with paired NYHA functional class data, NYHA functional classes I/II increased from 16.4% (323/1,974) to 59.4% (1,173/1,974) at follow-up. Improvement was associated with lower body mass index, higher left ventricular ejection fraction, and less residual TR, whereas worsening was associated with lower tricuspid annular plane systolic excursion/systolic pulmonary artery pressure and more residual TR.

CONCLUSIONS: In the large real-world EuroTR cohort, baseline NYHA functional class is a strong, independent predictor of 2-year mortality. Symptom trajectories were associated with body mass index, left ventricular ejection fraction, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, and residual TR.
Date Issued
2026-08-28
Publication Type
Article
Subject(s)
Subjects
EuroTR
•
NYHA
•
T-TEER
•
tricuspid regurgitation
Language(s)
en
Author(s)
Wolff, Charlotte
Sagmeister, Paula
Fengler, Karl
Kresoja, Karl-Patrik
Fortmeier, Vera
Rottbauer, Wolfgang
Pauschinger, Christoph
von Stein, Jennifer
Goebel, Bjoern
Denti, Paolo
Voss, Fabian
Adamo, Marianna
Barreiro-Perez, Manuel
Achouh, Paul
Rassaf, Tienush
Boekstegers, Peter
Stolte, Thorald
Schlegel, Philipp
Rubbio, Antonio Popolo
Patterson, Tiffany
Rück, Andreas
Benito-González, Tomás
Zdanyte, Monika
Vrijkorte, Martijn
Masiero, Giulia
Vincent, Flavien
Brunner, Stephanie
Rosch, Sebastian
Van Belle, Eric
Tarantini, Giuseppe
Swaans, Martin
Geisler, Tobias
Sánchez-Muñóz, Enrique
Grapsa, Julia
De Carlo, Marco
Bedogni, Francesco
Konstandin, Mathias H
Karam, Nicole
Mahabadi, Amir Abbas
Estévez-Loureiro, Rodrigo
Metra, Marco
Polzin, Amin
Maisano, Francesco
Lauten, Philipp
Iliadis, Christos
Kalbacher, Daniel
Besler, Christian
Kessler, Mirjam
Rudolph, Volker
Lurz, Philipp
Hausleiter, Jörg
Thiele, Holger
Stolz, Lukas
Kister, Tobias
Additional Credits
Journal
JACC: Advances
Publisher
Elsevier
ISSN
2772-963X
Access(Rights)
open.access
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