In T-TEER patients, cardiac output and TAPSE/sPAP moderately predicted 1-yr clinical improvement with AUC of 0.730, supporting hemodynamics for patient selection.
Do invasive hemodynamic markers (TAPSE/sPAP, CO, PAPi) predict clinical improvement at one year in patients with significant tricuspid regurgitation treated with T-TEER or GDMT?
Invasive hemodynamic markers such as cardiac output and TAPSE/sPAP ratio may help predict clinical improvement following T-TEER for significant tricuspid regurgitation.
Absolute Event Rate: 0% vs 0%
Abstract Background Tricuspid transcatheter edge-to-edge repair (T-TEER) is an emerging therapeutic intervention for patients with significant tricuspid regurgitation (TR). However, patient selection for T-TEER remains challenging. Prior studies have identified several hemodynamic markers, including the TAPSE/systolic PAP ratio (TAPSE/sPAP), cardiac output (CO), and pulmonary artery pulsatility index (PAPi), as potentially predictive of relevant outcome. The prognostic utility of these parameters in guiding patient selection for T-TEER remains to be fully elucidated. Objective To generate hypothesis as regards the prognostic value of these three invasive hemodynamic markers obtained from right heart catheterization (RHC) in patients eligible to T-TEER in terms of clinical response at one year ("improvement" versus "worse or no change" – the main outcome of TRI-FR trial, based on clinical events (unscheduled hospitalization for heart failure, death, tricuspid surgery) as well as PGA, NYHA and KCCQ). Methods All randomized patients in TRI-FR (N = 300) were eligible and analyzed, except those who withdrew their consent (N = 5), those allocated to T-TEER who experience a technical failure (TR grade 4+ or more in post-intervention) (N = 25), and those who had missing values for at least one of three RHC markers (N = 66). In each treatment arm, a linear relationship between RHC markers and outcome was first assessed using a generalized additive model, transformations were then applied accordingly. We fitted univariate and multivariable logistic regression models. The performances of the final model were investigated through discrimination, expressed as the area under the receiver-operating curve (AUC) and calibration (graphically). Results Out of 148 patients allocated to guideline directed medical therapy (GDMT) alone, and 152 patients allocated to T-TEER on top of GDMT, 109 and 100 were analyzed, and an improvement was observed in 39 out of 106 (36.8%) and 77 (77.8%) out of 99 patients assessed, respectively. In the GDMT alone arm, PAPi (log-transformed) and CO (3-degree polynomial) moderately predicted improvement (AUC = 0.696 and calibration far from good). In the T-TEER on top of GDMT, CO (3-degree polynomial) and TAPSE/sPAP (2-degree polynomial) moderately predicted improvement (AUC = 0.730 and moderate calibration). There were no significant relationship between hemodynamic measures and change in KCCQ or in 6-minute walk distance. Conclusion Key hemodynamic measures might be taken in account for patient selection for tricuspid valve interventions. This hypothesis has to be confirmed and probably added to other key clinical, biological and echocardiographic parameters.
Donal et al. (Sat,) reported a other. In T-TEER patients, cardiac output and TAPSE/sPAP moderately predicted 1-yr clinical improvement with AUC of 0.730, supporting hemodynamics for patient selection.