Cardiac remodeling after tricuspid transcatheter edge-to-edge repair: From the right to the left ventricle

Abstract

The management of isolated functional tricuspid regurgitation (TR) is under ongoing investigations as recent interventional breakthrough, such as transcatheter edge-to-edge repair (TEER). We aimed to assess whether and how such device would affect right and left reverse remodeling over time. This is a monocentric, prospective cohort of 10 consecutive patients treated by TEER between 2019 and 2022 who underwent successive cardiac magnetic resonance. Clinical and echocardiographic follow-up was performed up to 12 months after intervention. Overall patients were 81 [IQR: 77.5; 84.0] years old and 6 (60%) were women. TTE derived TR was reduced to stage moderate or less in 80% patients (n = 8) at discharge (P < 0.001) and in 77% (n = 7) at 1 year (P < 0.001) compared with 0% at baseline. CMR-derived Left ventricular ejection fraction (LVEF) and left cardiac output improved from 45 [IQR: 40; 56]% to 57 [IQR: 47; 57]% (P = 0.019) and from 2.6 [IQR: 2.1; 2.9] L/min/m2 to 3.1 [IQR: 2.6; 3.7] L/min/m2 (P = 0.020). The interobserver reliability of LVEF before and after TEER was r2 = 0.95 (P < 0.001) versus 0.95 (P < 0.001). Right ventricle end-diastolic volume (RVEDV) decreased from 107 mL/m2 [IQR: 75; 138] to 87 [IQR: 67; 115.0] mL/m2 (P = 0.039). There was no change in native T1 mapping. We found no non-ischemic late gadolinium enhancement. At 12 months, 67% of CMR patients presented with NYHA class I/II and KCCQ overall summery score increased from baseline 46 [IQR: 30.0; 49.1] to 66 [IQR: 57.4; 73.9] (P = 0.001). TR TEER led to encouraging reverse remodeling of the left ventricle, combining a large increase in LVEF, cardiac output and LV stroke volumes. As we found no changes in myocardial fibrosis, our results suggest a tight interdependence between both ventricles and question the role played by the RV on left ventricular efficiency. Outcomes were consistent with clinical amelioration.