Key result
TR improvement after TMVR linked to ~55% lower 1-year mortality or HF hospitalization.
Why the study?
Tricuspid regurgitation frequently coincides with severe mitral regurgitation, and transcatheter mitral valve replacement may secondarily affect tricuspid regurgitation severity, but its incidence and prognostic value were unclear.
Does tricuspid regurgitation improvement after transcatheter mitral valve replacement reduce all-cause mortality or heart failure hospitalization in patients with symptomatic mitral regurgitation and baseline tricuspid regurgitation?
Does tricuspid regurgitation improvement after transcatheter mitral valve replacement reduce all-cause mortality or heart failure hospitalization in patients with symptomatic mitral regurgitation and baseline tricuspid regurgitation?
Tricuspid regurgitation improvement (≥1-grade reduction) occurs in approximately one-third of patients following transcatheter mitral valve replacement and is independently associated with a significantly lower risk of 1-year mortality or heart failure hospitalization.
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TR improvement after TMVR may identify lower-risk patients; leaves open causality and requires randomized confirmation before practice change.
Background Tricuspid regurgitation (TR) frequently coincides with severe mitral regurgitation (MR). Transcatheter mitral valve replacement (TMVR) effectively eliminates MR and may secondarily affect TR severity. Aims This study aimed to assess incidence and prognostic value of TR improvement after TMVR using data from an international multicentre registry. Methods and results Patients with symptomatic MR and baseline TR undergoing TMVR from the CHOICE-MI international multicentre registry were analysed. TR improvement was defined as a ≥1-grade TR reduction at discharge. The primary endpoint was all-cause mortality or heart failure (HF) hospitalization at 1 year. Stepwise Cox regression was performed to assess the adjusted prognostic impact of TR improvement. Among 309 patients (median age 77 years), TR improvement occurred in 33.0% after TMVR. Patients with TR improvement were younger, had higher EuroSCORE II, less coronary artery disease, and lower baseline TAPSE. MR was durably eliminated in most patients, irrespective of TR evolution. At 1 year, there was no statistically significant difference in all-cause mortality or HF hospitalization between patients with and without TR improvement (27.0% vs. 36.9%; p=0.14). Following stepwise Cox regression, TR improvement was an independent predictor of all-cause mortality or HF hospitalization 1 year after TMVR (HR 0.45, 95% CI 0.23–0.88; p=0.02). Conclusion TR improvement occurs frequently following TMVR and is associated with favourable 1-year outcomes. These results support the clinical relevance of concomitant TR and the systematic assessment of TR after TMVR.
Heide et al. (2026) studied this question. Tricuspid regurgitation improvement occurred in 33% after TMVR and independently predicted lower 1-year mortality or heart failure hospitalization (HR 0.45, p=0.02).
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