Prediction of tricuspid regurgitation regression after mitral valve transcatheter edge-to-edge repair using three-dimensional transoesophageal echocardiography

TL;DR

This study identifies three-dimensional echocardiographic predictors of tricuspid regurgitation regression after a specific heart valve repair procedure, helping improve patient selection and outcomes.

Contribution

The study introduces tricuspid valve annulus perimeter as a strong predictor of tricuspid regurgitation regression following mitral valve repair.

Findings

Tricuspid valve annulus perimeter was the strongest predictor of tricuspid regurgitation regression.

A cut-off of ≤13.75 cm for tricuspid valve annulus perimeter best predicted regression.

Changes in tricuspid valve annulus area also predicted regression.

Abstract

We aimed to identify three-dimensional echocardiographic predictors of tricuspid regurgitation (TR) regression in patients with functional TR of moderate or greater severity undergoing mitral valve transcatheter edge-to-edge repair to optimize patient selection and improve clinical outcomes.

This retrospective study analysed 61 patients (mean age 81.3 ± 7.6 years; 55.7% males) who underwent mitral valve transcatheter edge-to-edge repair. Two-dimensional transthoracic echocardiography was performed pre- and 1-month post-procedurally, while three-dimensional transoesophageal echocardiography was performed pre-procedurally. We collected data on clinical variables, medications, and detailed echocardiographic measurements to evaluate procedural outcomes. Tricuspid regurgitation severity was semiquantitatively assessed and categorized. At the 1-month follow-up, TR severity had regressed in 43% of patients. A lower prevalence of atrial fibrillation, smaller left atrial volume index, and smaller right atrial area were significantly associated with TR regression. Multivariate analysis revealed the tricuspid valve annulus perimeter, area, and area change as significant predictors of post-procedure TR regression; tricuspid valve annulus perimeter was the strongest predictor among the three indicators [area under the receiver operating characteristic curve, 0.84 (95% confidence interval: 0.75–0.94), P < 0.001]. Receiver operating characteristic curve analysis indicated that tricuspid valve annulus perimeter cut-off of ≤13.75 cm was the best predictor of post-procedure TR regression. Additionally, tricuspid valve annulus area ≤13.55 cm² and annulus area change ≥17.5% were predictors of post-procedure TR regression.

In patients with relatively severe mitral regurgitation with a non-dilated tricuspid annulus and significant change in tricuspid valve annulus area, mitral valve transcatheter edge-to-edge repair may lead to TR regression.

graphical abstractIdentifying predictors of TR regression in patients undergoing MV-TEER

Identifying predictors of TR regression in patients undergoing MV-TEER

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