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Invasive Hemodynamics and Risk Stratification in T-TEER: Moving Beyond ESC Thresholds - EuroTR Registry Insights
Giulia Masiero1, Federico Arturi1, Sara Ceni1
1Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua, Italy (G.M., F.A., S.C., A. Panza, G.T.).
Circulation. Cardiovascular Interventions
|November 14, 2025
Summary
Right heart catheterization is vital for transcatheter tricuspid valve repair. Elevated pulmonary capillary wedge pressure predicts worse outcomes, highlighting its role in risk stratification for better patient results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Right heart catheterization (RHC) is crucial for evaluating patients undergoing transcatheter tricuspid valve edge-to-edge repair (TEER).
- This study investigates the influence of RHC-derived hemodynamic parameters on patient-centered outcomes following TEER.
Purpose of the Study:
- To explore the impact of invasive hemodynamic parameters from RHC on patient-centered outcomes in TEER procedures.
- To identify prognostic thresholds for adverse events after TEER.
Main Methods:
- A subanalysis of the multicenter EuroTR registry included 711 patients undergoing isolated TEER.
- Outcomes assessed were 2-year all-cause death/hospitalization for heart failure (HFH) and a 6-month composite of mortality, HFH, and NYHA class.
- Secondary outcome was postprocedural NYHA class improvement.
Main Results:
- Two-year survival free from death/HFH was 63%.
- Optimal prognostic thresholds included mean pulmonary artery pressure ≥32 mmHg, pulmonary capillary wedge pressure (PCWP) ≥20 mmHg, and pulmonary vascular resistance ≥5 Wood units.
- Elevated PCWP (≥20 mmHg) independently predicted early clinical deterioration (HR 2.77) and 2-year death/HFH (HR 1.75).
- NYHA class improved overall, but patients with elevated mean pulmonary artery pressure or PCWP experienced less symptomatic benefit.
Conclusions:
- Invasive hemodynamics, particularly elevated PCWP, are independently linked to early and late adverse outcomes in TEER patients.
- Despite functional improvements, higher hemodynamic pressures correlate with reduced symptomatic benefit.
- Comprehensive RHC aids in preprocedural risk stratification for TEER.
