Three-dimensional echocardiography-derived right ventricular forward stroke volume to end-systolic volume index in tricuspid valve transcatheter edge-to-edge repair

Background The ratio of right ventricular (RV) forward stroke volume (SV) to end-systolic volume (SV/RVESV), derived from three-dimensional (3D) echocardiography, has emerged as a noninvasive surrogate of RV-pulmonary artery (PA) coupling and is prognostically relevant in conservatively managed tricuspid regurgitation (TR). However, its role in patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) remains unknown. Purpose To evaluate the prognostic value of SV/RVESV in patients undergoing T-TEER for severe TR. Methods This single-center retrospective study included consecutive patients undergoing T-TEER (2020–2023) with complete 3D RV volumetric data at baseline and discharge. The primary endpoint was 2-year survival. Results Seventy-five patients (median age 81 years; 65% female; 72% NYHA III/IV) had a median baseline SV/RVESV of 0.422 (0.353–0.521), increasing to 0.478 (0.359–0.592) at discharge (P=0.034). A baseline SV/RVESV >0.395 (High) was associated with superior 2-year survival compared with ≤0.395 (Low) (90.4% [95%CI: 80.4–100%] vs. 68.3% [95%CI: 51.8–90.2%]; P=0.021). Patients with low SV/RVESV had larger RV volumes, reduced RV function, and more advanced TR. Acute increases in SV/RVESV were confined to patients with residual TR ≤II, whereas no significant changes occurred in those with residual TR >II. Residual TR ≤II rates were similar between groups. Conclusion In patients undergoing T-TEER, baseline RV forward SV/RVESV was strongly associated with long-term survival. High SV/RVESV patients had less advanced RV remodeling, underscoring its potential for preprocedural risk stratification and timely intervention.