Integrated Echocardiographic Assessment of Severe Tricuspid Regurgitation and Outcomes After Transcatheter Therapy

Abstract The management of severe tricuspid regurgitation (TR) remains a major clinical challenge, particularly in elderly patients at high surgical risk. Two– and three–dimensional transthoracic (TTE) and transesophageal echocardiography (TEE) play a pivotal role in the anatomical and functional assessment of the tricuspid valve, patient selection and post–procedural follow–up. Methods Fifty consecutive patients with severe TR underwent comprehensive 2D/3D TTE and TEE evaluation. In a subgroup of patients (n = 16), echocardiographic parameters were compared with invasive hemodynamic measurements obtained by right heart catheterization. 20 patients were treated with transcatheter tricuspid valve interventions (TTVI). Clinical and echocardiographic outcomes were assessed up to 2 years, and the predictive value of baseline echocardiographic parameters was analysed. Results The study population was predominantly elderly (77 ± 7 years), at high surgical risk, and severely symptomatic (86% NYHA class III–IV). TR etiology was mainly functional (84%). A high degree of agreement was observed between TTE and TEE in the assessment of tricuspid valve anatomy, right ventricular dimensions, and function. Significant differences emerged only in the quantification of EROA and RVol with TTE showing greater sensitivity in grading TR severity. Echocardiographic estimates of PAPs correlated well with invasive measurements. Right ventricular functional parameters (TAPSE, FAC, RV strain) and the ventriculo–arterial coupling index (TAPSE/PAPs) showed significant correlations with pulmonary pressures, vascular resistance, and cardiac output. Among patients undergoing TTVI, a significant and sustained improvement in NYHA functional class, TR severity and regurgitant volume, right ventricular systolic function, and pulmonary pressures was observed. Predictive analyses demonstrated that higher baseline TAPSE, FAC, and TAPSE/PAPs values were consistently associated with better clinical outcomes and lower diuretic requirements throughout follow–up, up to 2 years. Conclusions Comprehensive 2D/3D TTE and TEE provide a reliable and integrated assessment of severe TR and RV function, with good agreement with invasive hemodynamic data. TTVI are effective in improving symptoms, RV performance, and TR severity. Baseline RV functional and ventriculo–arterial coupling parameters represent valuable prognostic tools for patient selection and mid– to long–term risk stratification