Ventricular Interaction and Clinical Outcomes in Patients Undergoing Transcatheter Tricuspid Valve Repair

Tricuspid regurgitation (TR) causes right ventricular volume overload, which can negatively affect left ventricular (LV) hemodynamic status through ventricular interaction.

The aim of this study was to examine the association between ventricular interaction and clinical outcomes in patients undergoing transcatheter tricuspid valve repair (TTVr).

LV eccentricity index was retrospectively assessed using the parasternal short-axis view in 304 patients undergoing TTVr. Increased ventricular interaction was defined as LV eccentricity index ≥1.2. The primary outcome was a composite of mortality and heart failure hospitalization within 1 year.

The mean LV eccentricity was 1.23 ± 0.20, and 168 of 304 patients (55.3%) had LV eccentricity index ≥1.2. The median follow-up length was 384 days (Q1-Q3: 189-734 days). LV eccentricity index ≥1.2 was independently associated with a higher risk for the composite outcome (adjusted HR: 1.66; 95% CI: 1.04-2.65; P = 0.034). Among 168 patients with LV eccentricity index ≥1.2 at baseline, 83 (49.4%) showed improvement in LV eccentricity index to <1.2 at discharge and had a lower risk for the composite outcome than those with persistently increased LV eccentricity index (LV eccentricity index ≥1.2 at discharge). Smaller right ventricular area, larger left atrial volume index, greater reduction in TR severity, and procedural success were related to the improved LV eccentricity index.

Ventricular interaction, assessed by LV eccentricity index, was associated with clinical outcomes after TTVr, and its postprocedural improvement was linked to better outcomes. Assessment of ventricular interaction may be helpful for risk stratification and patient selection in TTVr.