Advanced hemodynamic parameters as indicators of clinical outcomes in patients undergoing transcatheter tricuspid annuloplasty

Abstract Background The evaluation of the right ventricle (RV) function is crucial in any patient undergoing transcatheter tricuspid valve intervention (TTVI). Advanced hemodynamic parameters (AHP) of the RV function such as the pulmonary pulsatility index (PAPi), the right atrial pressure to pulmonary capillary wedge pressure (RAP/PCWP) ratio and the right ventricular stroke work index (RVSWI) have been introduced to enhance risk stratification in cardiogenic shock. Low PAPi has been associated with unfavourable outcomes in patients who underwent TTVI; however, complete AHP of the RV function have not been studied in patients who underwent transcatheter tricuspid annuloplasty with the Cardioband system. Purpose To evaluate the prognostic significance of AHP of the RV function in patients undergoing transcatheter tricuspid annuloplasty with the Cardioband system. Methods Patients with significant tricuspid regurgitation who underwent Cardioband tricuspid annuloplasty from September 2019 to December 2024 were prospectively enrolled. All patients had a right heart catheterization before the procedure. Clinical outcomes were stratified according to each hemodynamic parameter. Patients evaluated with the PAPi were organized in three groups (with a lower value meaning a worst RV function): PAPi 1; PAPi 1–2; PAPi 2. Patients were also divided according to the cut-off value of the RAP/PCWP ratio, considering a worst RV function a value of ≥0.83. Lastly, patients were classified with a RVSWI value of 5.44 g/m/beat/m² which represents a worst RV function. Cut-off values were based on prior studies’ reported values. The primary endpoint of survival analysis was all-cause mortality. The Kaplan-Meier method was used to estimate the cumulative event rates, which were compared by means of the log-rank test. Results A total of 59 patients were included with a mean age of 78 ± 7 years, most of them female (83%). The mean follow-up was 25 ± 17 months and all-cause mortality was 19%. RV function measured with the RAP/PCWP ratio and the RVSWI showed no significant difference in survival (log-rank test, p = 0.27 and p = 0.76, respectively). On the other hand, survival of patients was lower (log-rank test 0.02) in patient with PAPi 1 with a mean follow-up of 20 ± 15 months, compared to those with a PAPi of 1–2 and 2, with a mean follow-up 26 ± 16 and 25 ± 18 months, respectively. Conclusions Evaluation of the RV function with hemodynamic markers improve the risk stratification in patients undergoing TTVI; however, our results suggest that in patients with a direct tricuspid annuloplasty with the Cardioband system, hemodynamics parameters such as the RAP/PCWP and the RVSWI had no significant difference in survival. Additionally, our study hints that only the evaluation of the RV function with the PAPi appears to be a good prognosis predictor in patients undergoing a Cardioband procedure; nevertheless, further studies that are needed to validate our findings.Survival estimate with PAPi