Aims:

Right ventricular geometry and function are thought to play a major role in the outcome of patients with tricuspid regurgitation undergoing transcatheter tricuspid intervention (TTVR). This study investigated the right ventricular remodeling using cardiac magnetic resonance imaging in patients undergoing TTVR.

Methods and results

Cardiac magnetic resonance imaging and echocardiography were performed in 20 patients with at least severe tricuspid regurgitation and symptomatic heart failure (NYHA ≥ II) before and 3 months after interventional transcatheter tricuspid intervention (13 cases with direct annuloplasty and 7 cases with edge-to-edge repair). Mean age of the patients was 79.4 ± 4.7 years and 50.0% of them were female. Technical success could be achieved in all cases. However, 3 patients presented a reduction of tricuspid regurgitation less than 2 grades (tricuspid regurgitation ≥ 3 at follow up 15%; p<0.001). Three months after intervention, cardiac dimensions decreased significantly (mean maximum right atrial volume: from 215 ± 74 ml to 187 ± 77 ml, p=0.048; right ventricular end-diastolic volume: from 199 ± 67 ml to 163 ± 64 ml, p=0.001) accompanied by a correspondingly decreased pendulum volume in the superior (p=0.011) and inferior vena cava (p=0.008).

Additionally, although right ventricular stroke volume significantly decreased (from 97.9 ± 30.4 ml to 73.3 ± 23.5, p=0.003), forward volume through the ascending aorta increased (55.5 ± 15.2 ml to 63.7 ± 17.1 ml, p=0.03) indicating a more effective and efficient cardiac function. Accordingly, the functional capacity (NYHA class ≤ II 60.0%, p< 0.001) and the exercise capacity of the patients (six-minutes walked distance: from 244.3 ± 105.9 m to 325.7 ± 111.13 m, p<0.008) significantly improved.

Discussion/Conclusion

Cardiac magnetic resonance imaging revealed that transcatheter tricuspid valve treatment resulted in remarkable right heart remodeling with significantly improved cardiac function and increased forward stroke volume leading to improved exercise capacity in patients with symptomatic tricuspid regurgitation.