Stolz, LukasLukasStolzKresoja, Karl-PatrikKarl-PatrikKresojavon Stein, JenniferJennifervon SteinFortmeier, VeraVeraFortmeierKoell, BenediktBenediktKoellRottbauer, WolfgangWolfgangRottbauerKassar, MohammadMohammadKassar0000-0002-7576-2224Goebel, BjoernBjoernGoebelDenti, PaoloPaoloDentiAchouh, PaulPaulAchouhRassaf, TienushTienushRassafBarreiro-Perez, ManuelManuelBarreiro-PerezBoekstegers, PeterPeterBoekstegersRück, AndreasAndreasRückDoldi, Philipp MPhilipp MDoldiNovotny, JuliaJuliaNovotnyZdanyte, MonikaMonikaZdanyteAdamo, MariannaMariannaAdamoVincent, FlavienFlavienVincentSchlegel, PhilippPhilippSchlegelvon Bardeleben, Ralph StephanRalph Stephanvon BardelebenStocker, Thomas JThomas JStockerWeckbach, Ludwig TLudwig TWeckbachWild, Mirjam GMirjam GWildBesler, ChristianChristianBeslerBrunner, StephanieStephanieBrunnerToggweiler, StefanStefanToggweilerGrapsa, JuliaJuliaGrapsaPatterson, TiffanyTiffanyPattersonThiele, HolgerHolgerThieleKister, TobiasTobiasKisterTarantini, GiuseppeGiuseppeTarantiniMasiero, GiuliaGiuliaMasieroDe Carlo, MarcoMarcoDe CarloSticchi, AlessandroAlessandroSticchiKonstandin, Mathias HMathias HKonstandinVan Belle, EricEricVan BelleMetra, MarcoMarcoMetraGeisler, TobiasTobiasGeislerEstévez-Loureiro, RodrigoRodrigoEstévez-LoureiroLuedike, PeterPeterLuedikeKaram, NicoleNicoleKaramMaisano, FrancescoFrancescoMaisanoLauten, PhilippPhilippLautenPraz, FabienFabienPrazKessler, MirjamMirjamKesslerKalbacher, DanielDanielKalbacherRudolph, VolkerVolkerRudolphIliadis, ChristosChristosIliadisLurz, PhilippPhilippLurzHausleiter, JörgJörgHausleiter2025-01-092025-01-092024-12-09https://boris-portal.unibe.ch/handle/20.500.12422/194506Background Atrial secondary tricuspid regurgitation (A-STR) has been proposed as an important etiologic subentity of secondary tricuspid regurgitation (STR). Patients with A-STR are frequently treated using transcatheter tricuspid valve edge-to-edge repair (T-TEER). Objectives The aims of this study were to evaluate prevalence and outcomes following T-TEER for severe A-STR and to compare the results to patients with nonatrial STR. Methods The study included patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry who underwent T-TEER for STR from 2016 until 2022. A-STR was defined as a ratio of end-systolic right atrial area to right ventricular area ≥1.5 in the presence of preserved right ventricular function (tricuspid annular plane systolic excursion >17 mm). The primary study endpoint was 2-year survival free from heart failure hospitalization. Secondary endpoints were 2-year survival, tricuspid regurgitation (TR) reduction at discharge and 1-year follow-up as well as changes in NYHA functional class. Results This study included 641 patients (50% women) with a mean age of 79 ± 7 years. The overall prevalence of A-STR was 31% (n = 196). A-STR was associated with a higher prevalence of atrial fibrillation, less frequent comorbidities, better biventricular function, less leaflet tenting, and larger atria. Although TR severity was comparable at baseline, patients with A-STR had more effective procedural TR reduction (TR ≤2+ in 86.9% vs 80.4% of those with nonatrial STR; P = 0.005). Although NYHA functional class improved in both STR subetiologies, the symptomatic burden was lower in patients with A-STR at the latest available follow-up (NYHA functional class ≥III in 46% of patients with nonatrial STR vs 38% in those with A-STR; P = 0.033). Beyond that, A-STR was associated with higher 2-year survival rates free from heart failure hospitalization (66.3% [Q1-Q3: 58.2%-75.5%] vs 47.5% [Q1-Q3: 41.7%-54.7%] in patients with nonatrial STR; P < 0.001). Median survival follow-up was 379 days [Q1-Q3: 155-697 days]. Conclusions A-STR is a common phenotype of STR and is associated with effective TR reduction and symptomatic reduction after T-TEER.enT-TEERatrial fibrillationatrial secondary tricuspid regurgitationfunctional secondary tricuspid regurgitation600 - Technology::610 - Medicine & healtharticle10.48620/845373966305810.1016/j.jcin.2024.10.028