Key result
CT-measured posterior iTAPSE >4.5 mm/m2 is linked to ~78% lower 1-year death or HF rehospitalization.
Why the study?
Echocardiographic TAPSE has failed to predict outcomes in severe TR after TTVI, prompting investigation into whether CT-captured TAPSE provides additional predictive value.
Does CT-based TAPSE predict death and rehospitalization in patients with severe tricuspid regurgitation undergoing transcatheter tricuspid valve intervention?
Cohort (n=75)
No
Does CT-based TAPSE predict death and rehospitalization in patients with severe tricuspid regurgitation undergoing transcatheter tricuspid valve intervention?
Effect estimate: HR 0.225 (95% CI 0.087-0.581)
Absolute Event Rate: 17.2% vs 63.6%
p-value: p=<0.001
CT-measured posterior indexed TAPSE is an independent predictor of cardiovascular outcomes and refines risk stratification in patients undergoing transcatheter tricuspid valve intervention.
CT iTAPSE >4.5 mm/m² may refine TTVI risk stratification; leaves open prospective validation before clinical adoption.
Background The tricuspid annular plane systolic excursion (TAPSE) assessed by echocardiography has failed in predicting outcomes in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI). Considering the complex shape of the tricuspid annulus and right ventricle, as well as the difficult echocardiographic image acquisition of the right heart, cardiac computed tomography (CT) might be superior for the analysis of the annular excursion. Thus, this study aimed to analyze whether CT-captured TAPSE provides additional value in predicting outcomes after TTVI. Methods and results For TTVI procedure planning, 75 patients (mean age, 77 ± 8 years; 61% female) with severe TR underwent full cardiac cycle CT. Septal, lateral, anterior, and posterior TAPSE, as well as TAPSE- volume, were analyzed. Indexed anterior and posterior (iTAPSE) and TAPSE volume were reduced in patients with right ventricular ejection fraction <45%. At 1 year after TTVI (mean follow-up, 193 ± 146days), the combined endpoint of death and rehospitalization occurred in significantly fewer patients with posterior iTAPSE >4.5 mm/m 2 (17.2% vs. 63.6%; HR 0.225, CI 0.087–0.581; P < 0.001) and in patients with iTAPSE volume >9 ml/m 2 (16.4% vs. 57.1%; HR: 0.269 CI 0.105–0.686; P = 0.003). Echocardiographic TAPSE correlated best with lateral CT-based TAPSE, although both failed in predicting outcomes after TTVI. In multivariate Cox regression, posterior iTAPSE was found to be a significant predictor of outcome 1 year after TTVI. Conclusions Posterior iTAPSE is an independent predictor of cardiovascular outcomes among patients undergoing TTVI. Furthermore, CT-measured TAPSE has incremental value and refines risk stratification for clinical outcomes in patients undergoing TTVI.
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Kirchner et al. (2025) conducted a cohort in Severe tricuspid regurgitation undergoing transcatheter tricuspid valve intervention (n=75). Posterior iTAPSE >4.5 mm/m2 vs. Posterior iTAPSE <4.5 mm/m2 was evaluated on Composite of death from any cause or rehospitalization for heart failure (HR 0.225, 95% CI 0.087-0.581, p=<0.001). A posterior indexed tricuspid annular plane systolic excursion (iTAPSE) >4.5 mm/m2 measured by CT was associated with a significantly lower rate of death or heart failure rehospitalization at 1 year (HR 0.225).
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