Tricuspid regurgitation (TR) has been associated with higher morbimortality and a negative impact on quality of life.
In most cases, its main cause is a condition of the left heart. However, in lower proportion, it may also be due to significant right atrium dilation compared against the right ventricle (Atrial Secondary Tricuspid Regurgitation, A-SRT). The latter has not been studied enough and little is known about its prognosis.
Tricuspid edge-to-edge repair (T-TEER) has been shown safe and effective, improving quality of life and reducing hospitalization for cardiac failure. However, its efficacy in the context of A-SRT has not been thoroughly assessed.
This was a EuroTR Registry analysis including 641 patients with moderate to severe TR receiving T-TEER. 196 (30,5 %) of these patients presented A-SRT, while the rest had non-atrial secondary TR (N-SRT).
Read also: PULSE Registry Subanalysis: Radial vs. Femoral Secondary Access.
MitraClip, TriClip and PASCAL were used.
Mean patient age was 79. A-SRT patients showed higher prevalence of atrial fibrillation, less comorbidities and better biventricular function. Most were in functional class III-IV.
TR severity was 3+ in 47% of cases, 4+ in 41%, and 5+ in 18%.
After procedure, even though both groups saw TR reduction, the proportion of TR ≤ 2 was lower among A-SRT patients (86,9 % vs. 80,4 %; p=0,005).
Read also: Percutaneous Treatment of Tricuspid Regurgitation with K-CLIP.
At two-year follow-up, survival was significantly higher among A-SRT patients (66,7 % vs. 44,3 %; p<0,001), as was CF hospitalization reduction (66,3 % vs. 47,5 %; p<0,001). Both groups experienced improved functional class, but the proportion of patients with CF in functional class ≥ III was lower among A-SRT patients (38 % vs. 46 %; p=0,033).
Conclusion
A-SRT is a common STR phenotype associated to effective reduction of TR and improved symptoms after T TEER.
Original Title: Atrial Secondary Tricuspid Regurgitation Insights Into the EuroTR Registry.
Reference: Lukas Stolz, et al. JACC Cardiovasc Interv. 2024;17:2781–2791.
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