Baseline, echocardiographic characteristics and clinical outcomes of patients with atrial functional tricuspid regurgitation undergoing transcatheter repair: a systematic review and meta-analysis

Abstract Aims Atrial functional tricuspid regurgitation (AFTR) is a recently recognized subtype of tricuspid regurgitation (TR) with distinct features from ventricular functional TR (VFTR), potentially affecting procedural outcomes and survival. With growing use of transcatheter therapies for severe TR, identifying predictors of improved outcomes is crucial. This meta-analysis aims to compare baseline characteristics and procedural results between AFTR and VFTR patients undergoing transcatheter repair. Methods We conducted a systematic search across three electronic databases: MEDLINE/PubMed, Cochrane, and Web of Science, identifying studies comparing outcomes between AFTR and VFTR patients undergoing transcatheter repair. After selecting all available studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-analysis was performed. Results Five observational studies including 1,453 patients (391 AFTR, 1,062 VFTR) were analyzed—four using transcatheter edge-to-edge repair and one annuloplasty. Compared to VFTR, AFTR patients were more often female (RR 1.27, 95% CI 1.11–1.45), had less coronary artery disease (RR 0.83, 95% CI 0.71–0.96), lower NT-proBNP levels, and slightly older age. Echocardiographically, AFTR showed higher TAPSE, LVEF, and RVFAC, and smaller LVEDD, indicating better preserved cardiac function. Procedural TR reduction (≤ grade 2) was similar post-procedure and at 1 year, though AFTR patients had more NYHA I/II class improvement (RR 1.16, 95% CI 1.01–1.33). At 1 year, AFTR was associated with lower all-cause mortality (RR 0.32, 95% CI 0.16–0.62) and fewer heart failure hospitalizations (RR 0.64, 95% CI 0.50–0.82). Conclusion AFTR patients undergoing transcatheter repair show distinct profiles with better preserved function and improved survival compared to VFTR, despite similar TR reduction. Larger randomized trials are needed to clarify underlying mechanisms and guide patient selection.