Background

It remains uncertain whether tricuspid regurgitation (TR) contributes alone to the dismal outcome or acts in conjunction with right ventricular (RV) function. 

Methods and Results

We analyzed patients who underwent transcatheter edge-to-edge repair (TEER) with the MitraClip system for the treatment of mitral regurgitation (MR) in three centers in Germany from August 2010 to March 2019. A total of 744 patients had adequate echocardiographic data to assess TR and RV function and were included in the analysis. RV function was assessed as the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP). The primary outcome was a composite of all-cause mortality and heart-failure rehospitalization within one year. Among the study participants, severe TR was observed in 166 (22.3%) patients and was associated with the outcome (HR 1.91, 95%CI 1.41–2.59, p <0.001). Also, RV function was associated with an increased risk of the primary outcome (TAPSE/sPAP: HR 0.30, 95%CI 0.14–0.64, p=0.002). Patients were divided according to the TAPSE/sPAP ratio. The association of severe TR with the outcome was attenuated in patients with worse RV function (i.e. tertile 1, lower TAPSE/sPAP) (HR 1.57, 95%CI 0.92–2.70, p=0.09) but more pronounced in patients with better RV function (i.e. tertile 3, higher TAPSE/sPAP) (HR 3.39, 95%CI 1.79–6.43, p<0.001). We found a significant interaction between severe TR and the TAPSE/sPAP ratio (p=0.03). 

Conclusions

The clinical relevance of TR varies with its concomitant RV function in patients undergoing TEER to treat MR.