Prognostic clinical and echocardiographic indicators of two-year mortality after transcatheter tricuspid valve repair in patients with severe tricuspid regurgitation

Abstract Background Transcatheter tricuspid valve repair (TTVR) has emerged as a promising intervention for patients with severe tricuspid regurgitation (TR). Risk stratification is of importance on identifying high-risk patients post procedure. Purpose This study integrates clinical, biomarker, and advanced echocardiographic data to identify predictors of two-year mortality in patients undergoing TTVR. Methods This study enrolled 56 consecutive patients with severe TR (mean age 76±10 years; 43.5% male) underwent TTVR (TriClip: 80.4%, Cardioband: 19.6%) between 2021 and 2023. Clinical variables, serum biomarkers and echocardiographic parameters speckle-tracking-derived biventricular strain, right ventricular (RV) dimensions, and septal mitral annular velocity (e´) were assessed. Independent predictors of two-year all-cause mortality were explored by multivariable Cox regression analysis. Results Two-year mortality was 34.8% (16/46). Univariable outcome predictors were elevated NT-proBNP (3000 pg/mL, HR 6.98, 95% CI 1.94-25.17, P=0.003), septal e´ velocity (7 cm/s, HR 4.20, 95% CI 1.44-12.24, P=0.009), and increased basal right ventricular diameter (RVD 56 mm, HR 3.84, 95% CI 1.38-10.71, P=0.010). Multivariable analysis showed that NT-proBNP 3000 pg/mL (HR 5.36, 95% CI 1.46-19.66, P=0.011) and basal RVD 56 mm (HR 4.33, 95% CI 1.44-13.04, P=0.009) remained as independent risk factors associated with mortality after adjusting confounders. In addition, mortality rates increased with the number of risk factors: 11.8% (none), 35.7% (one), and 90.0% (two, P0.001). Patients at high-risk (with two risk factors) had a 9-fold higher mortality risk (90.0% vs. 22.6%; HR 9.21, 95% CI 3.17–26.78, P0.001) as compared to patients without or with one risk factor. Present risk model demonstrated good prognostic performance, with a sensitivity of 0.56 (95% CI 0.31–0.79), specificity of 0.96 (95% CI 0.78–1.00), positive predictive value of 0.90 (95% CI 0.54–0.99), and negative predictive value of 0.77 (95% CI 0.58–0.90). Conclusions This study indicates combining NT-proBNP and basal RV values could effectively stratify chronic mortality risk post-TTVR. Future studies are needed to validate the prognostic value of NT-proBNP and basal RV dimension in patients undergoing TTVR.FigureKaplan-Meier Curves