Prognostic value of transthoracic echocardiographic findings in patient with tricuspid regurgitation

Abstract Background: Severe tricuspid regurgitation (TR) is associated with right ventricular remodeling and adverse clinical outcomes. Percutaneous therapies have emerged as alternatives for high-surgical-risk patients, but data on patient profiling, imaging predictors, and outcomes remain limited. Objectives: This prospective observational study aimed to (1) characterize the anatomical, echocardiographic, and clinical profile of patients with significant TR and (2) evaluate the short- and mid-term impact of percutaneous interventions on TR severity, right-heart remodeling, and clinical outcomes. Secondary objectives included validation of 2D and 3D echocardiographic parameters for procedural success prediction and identification of prognostic indicators for mortality or heart failure rehospitalization. Methods: Fifty symptomatic patients with severe TR (≥4+) and NYHA class ≥ II were consecutively enrolled between December 2022 and December 2024. All underwent comprehensive 2D and 3D transthoracic and transesophageal echocardiography, right-heart catheterization, and Heart Team evaluation for percutaneous intervention eligibility. Echocardiographic measurements were analyzed offline in a double-blind fashion. Twenty patients underwent percutaneous treatment: 10 edge-to-edge repairs (Triclip), 2 annuloplasties (Cardioband), and 8 transcatheter valve replacements (TricValve). Results: Percutaneous therapy resulted in significant reduction of TR severity, regurgitant volume, and pulmonary pressures, along with improved right ventricular systolic function and myocardial deformation. Pre-procedural echocardiographic parameters—including TAPSE, FAC, longitudinal strain, PAPs, and ventriculo-arterial coupling indices—were predictive of clinical improvement and lower diuretic requirements at 30 days, 6 months, and 2 years of follow-up. No intra- or periprocedural complications were reported, though early mortality occurred in 4 patients. Conclusions: Percutaneous interventions for severe TR effectively reduce regurgitation and improve right ventricular function. Advanced echocardiographic assessment provides critical guidance for patient selection, procedural planning, and outcome prediction, supporting the expanding role of transcatheter therapies in high-risk populations.