Giulia Masiero, Federico Arturi, Sara Ceni, Andrea Panza, Karl‐Patrik Kresoja, Jennifer von Stein, Vera Fortmeier, Benedikt Koell, Wolfgang Rottbauer, Mohammad Kassar, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro‐Pérez, Peter Boekstegers, Andreas Rück, Monika Zdanytė, Marianna Adamo, Flavien Vincent, Philipp Schlegel, Sebastian Rosch, Mirjam G. Wild, Christian Besler, Stefan Toggweiler, Stephanie Brunner, Julia Grapsa, Tiffany Patterson, Hölger Thiele, Tobias Kister, Alessandro Sticchi, Marco De Carlo, Fabian Voß, Amin Polzin, Antonio Popolo Rubbio, Francesco Bedogni, Thorald Stolte, Thomas Nestelberger, Tomás Benito‐González, Enrique Sánchez-Muñóz, Mathias H. Konstandin, Éric Van Belle, Marco Metra, Tobias Geisler, Rodrigo Estévez‐Loureiro, Amir A. Mahabadi, Nicole Karam, Francesco Maisano, Philipp Lauten, Fabien Praz, Mirjam Keßler, Daniel Kalbacher, Volker Rudolph, Christos Iliadis, Philipp Lurz, Jörg Hausleiter, Lukas Stolz, Giuseppe Tarantini, Karl‐Philipp Rommel, Ralph Stephan von Bardeleben, Roman Pfister, Stephan Baldus, Philipp von Stein, Muhammed Gerçek, Felix Rudolph, Hazem Omran, Sebastian Ludwig, Christoph Pauschinger, Leonhard‐Moritz Schneider, Matthias Gröger, Dominik Felbel, Carsten Salomon, Harald Lapp, Quentin de Baynast, Alain Berrebi, Florian Schindhelm, Berenice Caneiro‐Queija, Julio Echarte‐Morales, Andreas Goldschmied, Edoardo Pancaldi, Elisa Pezzola, Mauro Massussi, Laura Lupi, Natacha Rousse, Samy Aghezzaf, Sirin Bakhtari, Norbert Frey, Martin Kraus, Dirk Westermann, Matteo Mazzola, Cristina Giannini, Anke von Peter, Julia Novotny, Ludwig T. Weckbach, Thomas J. Stocker, Kaspar Volz, Katalin Berschiminski, Philipp M. Doldi, Hannah Kempton, Dario Grassini
BACKGROUND: Right heart catheterization plays a pivotal role in the preprocedural evaluation of patients considered for transcatheter tricuspid valve edge-to-edge repair. This study aimed to explore the potential impact of hemodynamic parameters obtained through right heart catheterization on patient-centered outcomes. METHODS: This study represents a subanalysis from the multicenter EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation). Patients with invasive hemodynamic data who underwent isolated transcatheter tricuspid valve edge-to-edge repair for significant tricuspid regurgitation were included. Outcomes of interest were a composite of 2-year all-cause death or hospitalization for heart failure (HFH) and a patient-centered composite of 6-month all-cause mortality, HFH, New York Heart Association class IV/worsening New York Heart Association class compared with baseline. Secondary outcome included postprocedural New York Heart Association class improvement. RESULTS: Seven hundred and eleven patients were included in the analysis. Two-year survival free from death and HFH was 63%. Optimal prognostic thresholds identified for death and HFH at 2 years were: mean pulmonary artery pressure≥32 mm Hg, pulmonary capillary wedge pressure (PCWP)≥20 mm Hg, and pulmonary vascular resistance≥5 wood units (WU). The early patient-centered composite outcome occurred in 25% of cases. PCWP≥20 mm Hg was independently associated with an early clinical deterioration (hazard ratio, 2.77 [95% CI, 1.47–5.28]; P <0.001) and with 2-year death/HFH (hazard ratio, 1.75 [95% CI, 1.03–3.02]; P =0.04). No invasive parameter was associated with residual tricuspid regurgitation ≥3+. New York Heart Association class improved significantly throughout the follow-up ( P <0.001), although patients with elevated mean pulmonary artery pressure ( P =0.04) or PCWP ( P <0.01) experienced less symptomatic benefit. CONCLUSIONS: In patients undergoing transcatheter tricuspid valve edge-to-edge repair, invasive hemodynamics—especially elevated PCWP—are independently associated with early patient-centered outcomes and late adverse clinical events. Despite overall improvement of the functional status and no impact on residual tricuspid regurgitation, patients with higher mean pulmonary artery pressure or PCWP benefit less. These findings support the role of comprehensive right heart catheterization in preprocedural risk stratification. REGISTRATION: URL: https://clinicaltrials.gov ; Unique identifier: NCT06307262.