Left-sided heart failure determines outcomes in patients with severe tricuspid regurgitation undergoing percutaneous repair.
Publisher DOI
PubMed ID
41825486
Abstract
Aims
Tricuspid regurgitation (TR) frequently coexists with left-sided heart failure (HF). Tricuspid valve transcatheter edge-to-edge repair (T-TEER) has emerged as a treatment for severe TR, yet the prognostic role of coexisting HF phenotypes remains unclear.Methods And Results
In the EuroTR registry, we assessed the impact of HF subtypes on 2-year all-cause mortality after T-TEER. Patients were stratified by left ventricular ejection fraction (LVEF) into reduced/mildly reduced (HFmrEF/HFrEF <50%) and preserved (≥50%). Those with preserved LVEF were further divided by pulmonary capillary wedge pressure (PCWP) into HFpEF (>15 mmHg) and non-overt left-sided HF (≤15 mmHg). Among 1,773 patients, 30% had HFmrEF/HFrEF, 44% HFpEF, and 26% non-overt left-sided HF. Procedural success (TR ≤moderate) was highest in non-overt left-sided HF (87%) and lowest in HFmrEF/HFrEF (78%). Symptom burden improved across all groups (p<0.001). Estimated 2-year mortality was 25.0% in HFmrEF/HFrEF, 20.3% in HFpEF, and 13.1% in non-overt left-sided HF. Procedural success was associated with improved outcomes in all groups (p<0.01). Among successfully treated patients, survival was comparable between HFmrEF/HFrEF and HFpEF at 1-year but better in HFpEF at 2-years (p=0.027). Predictors of survival differed by phenotype: right ventricular function for HFmrEF/HFrEF, right-sided pressures for HFpEF, and baseline TR severity for non-overt left-sided HF.Conclusion
Consideration of left-sided pathologies in patients with significant TR is important as outcomes and predictors for survival differ. Across HF phenotypes, procedural success is associated with survival but the prognostic impact of TR reduction may unfold over time especially in HFpEF.
Tricuspid regurgitation (TR) frequently coexists with left-sided heart failure (HF). Tricuspid valve transcatheter edge-to-edge repair (T-TEER) has emerged as a treatment for severe TR, yet the prognostic role of coexisting HF phenotypes remains unclear.Methods And Results
In the EuroTR registry, we assessed the impact of HF subtypes on 2-year all-cause mortality after T-TEER. Patients were stratified by left ventricular ejection fraction (LVEF) into reduced/mildly reduced (HFmrEF/HFrEF <50%) and preserved (≥50%). Those with preserved LVEF were further divided by pulmonary capillary wedge pressure (PCWP) into HFpEF (>15 mmHg) and non-overt left-sided HF (≤15 mmHg). Among 1,773 patients, 30% had HFmrEF/HFrEF, 44% HFpEF, and 26% non-overt left-sided HF. Procedural success (TR ≤moderate) was highest in non-overt left-sided HF (87%) and lowest in HFmrEF/HFrEF (78%). Symptom burden improved across all groups (p<0.001). Estimated 2-year mortality was 25.0% in HFmrEF/HFrEF, 20.3% in HFpEF, and 13.1% in non-overt left-sided HF. Procedural success was associated with improved outcomes in all groups (p<0.01). Among successfully treated patients, survival was comparable between HFmrEF/HFrEF and HFpEF at 1-year but better in HFpEF at 2-years (p=0.027). Predictors of survival differed by phenotype: right ventricular function for HFmrEF/HFrEF, right-sided pressures for HFpEF, and baseline TR severity for non-overt left-sided HF.Conclusion
Consideration of left-sided pathologies in patients with significant TR is important as outcomes and predictors for survival differ. Across HF phenotypes, procedural success is associated with survival but the prognostic impact of TR reduction may unfold over time especially in HFpEF.
Date Issued
2026-03-14
Publication Type
Article
Subject(s)
Subjects
Ejection fraction
•
Heart failure
•
Right Ventricle
•
Tricuspid regurgitation
Language(s)
en
Author(s)
Rosch, Sebastian | |
Schöber, Anne R | |
Stolz, Lukas | |
Passoke, Felix | |
Rommel, Karl-Philipp | |
Zancanaro, Edoardo | |
Ruf, Tobias | |
von Stein, Jennifer | |
Fortmeier, Vera | |
Pauschinger, Christoph | |
Rottbauer, Wolfgang | |
Goebel, Bjoern | |
Denti, Paolo | |
Achouh, Paul | |
Rassaf, Tienush | |
Barreiro-Perez, Manuel | |
Boekstegers, Peter | |
Rück, Andreas | |
Zdanyte, Monika | |
Adamo, Marianna | |
Vincent, Flavien | |
Schlegel, Philipp | |
Besler, Christian | |
Brunner, Stephanie | |
Grapsa, Julia | |
Patterson, Tiffany | |
Thiele, Holger | |
Kister, Tobias | |
Tarantini, Giuseppe | |
Masiero, Giulia | |
De Carlo, Marco | |
Foss, Fabian | |
Polzin, Amin | |
Rubbio, Antonio P | |
Bedogni, Francesco | |
Konstandin, Mathias H | |
Van Belle, Eric | |
Metra, Marco | |
Geisler, Tobias | |
Estévez-Loureiro, Rodrigo | |
Mahabadi, Amir A | |
Karam, Nicole | |
Maisano, Francesco | |
Lauten, Philipp | |
Kessler, Mirjam | |
Kalbacher, Daniel | |
Rudolph, Volker | |
Iliadis, Christos | |
von Bardeleben, Ralph-Stephan | |
Lurz, Philipp | |
Hausleiter, Jörg | |
Kresoja, Karl-Patrik |
Additional Credits
Journal
European Journal of Heart Failure
Publisher
Oxford University Press
ISSN
1879-0844
1388-9842
Access(Rights)
restricted