Key result
T-TEER induced immediate anatomical left atrial unloading with a reduction in LAVI of 8.1 mL/m2, but filling pressure surrogates increased and atrial mechanical function did not recover.
Why the study?
The longitudinal effects of transcatheter tricuspid edge-to-edge repair on left atrial remodeling and diastolic physiology remain poorly characterized.
Does transcatheter tricuspid edge-to-edge repair (T-TEER) improve left atrial structure, function, and diastolic hemodynamics in patients with severe tricuspid regurgitation?
Cohort (n=125)
No
Does transcatheter tricuspid edge-to-edge repair (T-TEER) improve left atrial structure, function, and diastolic hemodynamics in patients with severe tricuspid regurgitation?
Transcatheter tricuspid edge-to-edge repair induces immediate anatomical left atrial unloading but does not restore left atrial mechanical function, and is associated with an acute increase in left-sided filling pressure surrogates.
Background Severe tricuspid regurgitation (TR) alters ventricular interaction and left-sided filling dynamics. However, the longitudinal effects of transcatheter tricuspid edge-to-edge repair (T-TEER) on left atrial (LA) remodeling and diastolic physiology remain poorly characterized. Aims To evaluate longitudinal changes in LA structure, function, and diastolic hemodynamics following T-TEER. Methods We studied 125 consecutive patients undergoing T-TEER within the TRI-FR trial and registry (median age 78 [73–81] years; 60.8% women; 73.6% atrial fibrillation). Comprehensive echocardiography was performed at baseline, pre-discharge, and at 6 and 12 months. Longitudinal changes in LA volume index (LAVI), peak atrial longitudinal strain (PALS), E/e′ ratio, left atrial stiffness index (LASI), and forward flow indices were analysed using linear mixed-effects models. Results LAVI decreased immediately after T-TEER (estimated change −8.1 mL/m2; 95% CI −14.6 to −1.6; adjusted P=0.033), but this reverse remodeling was not sustained at 12 months. In contrast, LA reservoir function deteriorated early and remained impaired throughout follow-up (PALS −1.2%; 95% CI −2.0 to −0.3; adjusted P=0.029). Estimated LV filling pressure increased acutely (E/e′ +3.26; 95% CI 2.34–4.18; adjusted P<0.001), while LASI remained elevated at 12 months (ratio 1.22; 95% CI 1.05–1.42; adjusted P=0.016). Stroke volume index and cardiac index did not change significantly over time (P=0.969 and P=0.562, respectively). Early mitral regurgitation worsening occurred in 20% of patients but was transient and unrelated to changes in diastolic or forward-flow parameters. Conclusions T-TEER induces immediate anatomical LA unloading but does not restore LA mechanical function. Despite early reductions in LA volume, filling pressure surrogates increased, LA stiffness remained elevated, and forward flow did not improve. These findings demonstrate a dissociation between structural and functional remodeling after TR correction and highlight the importance of serial assessment of LA mechanics and diastolic physiology following T-TEER.
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Rasmeehirun et al. (2026) conducted a cohort in Severe, symptomatic tricuspid regurgitation (n=125). Transcatheter tricuspid edge-to-edge repair (T-TEER) was evaluated on Change in left atrial volume index (LAVI) from baseline to pre-discharge (Estimated change -8.1 mL/m2, 95% CI -14.6 to -1.6, p=0.033). T-TEER induced immediate anatomical left atrial unloading with a reduction in LAVI of 8.1 mL/m2, but filling pressure surrogates increased and atrial mechanical function did not recover.
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