Tricuspid regurgitation and heart failure: the faith of treated vs untreated cohort in the percutaneous era

Abstract

Abstract Background/Introduction Tricuspid regurgitation (TR) is associated with heart failure and reduced survival.Within a short-time period, transcatheter tricuspid valve repair or replacement (TTVR)(TTVr) for TR has evolved from innovation to clinical reality. Still, most patients arrive in an advanced state of heart failure (HF), as well as most cohorts remained untreated for various reasons. The faith of these two therapeutic approaches gives differences in results among survival and clinical status at distance. Purpose The present study’s aim is to provide 1 year results between TR patients treated with TTVR and TTVr compared to untreated patients, in terms of cardiac survival, rehospitalization, right-side heart failure symptoms development, and NYHA improvement. The secondary endpoint is to analyze gender disparities as well as echocardiographic and medical therapy changes between groups. Methods 78 patients (pts) have been prospectively inserted into a dedicated database from January 2020 till January 2023. 26 pts (36%) have been treated with TTVR/r (Treated Group-TG) and 51 pts (65%) have been left untreated with medical therapy (MT) optimization (UN-Treated Group-UNTG). In TG, 9 (34%) underwent TEER (Transcatheter Edge-To-Edge Repair), 13 (50%) annuloplasty and 4(15%) TTVr. Tri-Score was used to define right-side pathology in both groups; the Tri-Score mean of 3.9 (8-1 +/- SD 1.68) was in TG, while 6,17 (10-2+/- SD 1.9) in UNTG. In UNTG 52% were female gender while 76%in TG. Most of the patients in UNTG were in TR stage 5 (47%) while in stage 4 in TG (42%). For 1 year follow-up (FUP), Kaplan-Meier weighted survival curves related to cardiac death and HF rehospitalization have been computed as well as Chi-squared test to evaluate right-side HF symptoms progression, echocardiographic changes in right ventricular function, NYHA progression and medical therapy changes, between the 2 groups. Results Analyzing the cardiac death between the 2 groups, there was a significant statistical difference since TG has a less incidence of exitus in the general population (p-value =0,05), Figure 1. Concerning gender, in female gender, the treated pts have lower cardiac death incidence (p-value =0,03).Concerning HF hospitalization, TG has a lower incidence with p-value =0,005, Figure 2. No difference according to gender. In TG there was a significant improvement in NYHA class at FUP (p-value =0,001) as well as an improvement of right-side HF symptoms (p-value =0,001). In UNTG there was a significant increase in the dosage of HF drugs compared to TG, (p-value =0,001) as well as an increase in right ventricular function and dimension at echocardiogram (p-value =0,001). Conclusion(s) this study shows that treatment in case of TR with right side HF has a positive impact upon cardiac death,HF hospitalisation at 1 year. As well as there is a significant improvement in clinical and ecocardiographic status at FUP in treated group.figure 1figure 2