Background/Objectives

Transcatheter tricuspid valve repair (TTVR) has shown promising results with persistent reduction of tricuspid regurgitation (TR) and significant improvements in NYHA class, quality of life and edema.

Purpose

Despite recent promising data, it is still unknown whether and in which extent interventional treatment of isolated tricuspid regurgitation objectively improves maximal or submaximal exercise capacity.

Methods

Constant work rate exercise time testing (CWRET) reflects submaximal / endurance exercise capacity, which is more likely to be relevant for daily life activities, and gives a more differentiated physiologic insight into the nature of exercise intolerance. Thus, 22 Patients with at least severe tricuspid regurgitation and symptomatic heart failure (NYHA ≥ II) underwent cardiopulmonary exercise testing by assessment of maximal oxygen uptake (peak VO₂) and submaximal exercise capacity (at 75% of maximal achieved work rate in the initial incremental exercise test) prior to TTVR and 3 months post-procedure (16 cases with direct annuloplasty and 6 cases with edge-to-edge repair).

Results

Mean age of the patients was 77.0 ± 8.7 years and 50% of them were female. Technical success could be achieved in all cases. Two patients presented a reduction of tricuspid regurgitation less than 2 grades (tricuspid regurgitation ≥ 3 at follow up 18.2%; p<0.001). Three months after intervention echocardiography revealed significantly improved right ventricular characteristics with decreased right ventricular basal diameter (from 48.0 ± 6.5 mm to 41.7 ± 6.5 mm; p<0.001), right atrial area (from 36.0 ± 9.9 cm² to 28.6 ± 7.3 cm²; p<0.001) and diameter of the inferior vena cava (from 24.6 ± 7.1 mm to 18.5 ± 6.2 mm; p=0.001). In terms of exercise capacity, exercise time at 75% of maximal achieved work rate significantly improved (from 331.8 ± 193.3 sec to 488.14 ± 289.9 sec p=0.001), reflecting a gain in submaximal exercise tolerance. Maximal oxygen uptake (peak VO₂) showed a positive trend, but no statistically significant difference (11.1 ± 3.4 ml/min/kg vs. 11.7 ± 2.7 ml/min/kg; p=0.312).

Discussion/Conclusion

Transcatheter tricuspid valve repair may have a beneficial effect on right ventricular remodeling. Furthermore, submaximal exercise capacity is significantly increased, reflecting an improvement especially regarding daily life activities in patients with severe tricuspid regurgitation.