Transcatheter Tricuspid Valve Replacement Eligibility as a Disease-Stage Framework for Prognostic Stratification in Secondary Severe Tricuspid Regurgitation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Secondary severe tricuspid regurgitation (n=1062). Intervention: TTVR eligibility classification (symptomatic status and TRISCEND II trial exclusion criteria) vs. Group 1 (asymptomatic / NYHA Class I). Primary outcome: Composite of all-cause death or heart failure hospitalization (HR 2.88, 95% CI 2.16-3.84, p=<0.001).

Q: What does this research mean for the field?

In patients with secondary severe tricuspid regurgitation, being symptomatic and meeting pivotal TTVR trial exclusion criteria is associated with a nearly threefold higher adjusted risk of death or heart failure hospitalization compared to asymptomatic patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kenya Kusunose; Hiroyuki Tsurumi; Takumi Imai; Akihiro Tokushige; Mamoru Manita; Minoru Wake

doi:10.1253/circrep.cr-26-0300

October 7, 2026Circulation ReportsOpen Access

Transcatheter Tricuspid Valve Replacement Eligibility as a Disease-Stage Framework for Prognostic Stratification in Secondary Severe Tricuspid Regurgitation

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Transcatheter tricuspid valve replacement (TTVR) has expanded treatment options for secondary severe tricuspid regurgitation, but the prognostic value of pivotal-trial eligibility criteria in real-world patients is unclear.

Does transcatheter tricuspid valve replacement (TTVR) eligibility based on pivotal trial criteria effectively stratify the prognosis of real-world patients with secondary severe tricuspid regurgitation?

Key Points

To assess whether pivotal trial eligibility criteria for transcatheter tricuspid valve replacement can stratify clinical outcomes and serve as a disease-staging framework in secondary severe tricuspid regurgitation.
Retrospective multicenter cohort study evaluating patients undergoing transthoracic echocardiography at 3 Japanese centers between 2014 and 2023.
Automated artificial intelligence analysis identified 1,165 patients aged ≥18 years with severe tricuspid regurgitation, stratified into 3 stages using TRISCEND II trial inclusion and exclusion criteria.
Risk of the composite endpoint of all-cause death or heart failure hospitalization increased stepwise, with an adjusted HR of 1.72 (95% CI 1.29–2.28; P<0.001) in TTVR-eligible patients and 2.88 (95% CI 2.16–3.84; P<0.001) in TTVR-ineligible patients.
Adding the eligibility classification to established prognostic factors significantly improved model discrimination (ΔC-index: 0.026, 95% CI 0.015–0.038; P<0.001), integrated discrimination improvement (0.036, 95% CI 0.019–0.061), and continuous net reclassification improvement (0.177, 95% CI 0.078–0.314).
Progression across eligibility stages was accompanied by continuous deterioration in right ventricular–pulmonary arterial coupling.

Study Design

Type

Cohort (n=1,062)

Multicenter

Yes

Structured PICO

Does transcatheter tricuspid valve replacement (TTVR) eligibility based on pivotal trial criteria effectively stratify the prognosis of real-world patients with secondary severe tricuspid regurgitation?

P

Population

1,062 adult patients with artificial intelligence-identified secondary severe tricuspid regurgitation, stratified by transcatheter tricuspid valve replacement eligibility criteria, followed for a median of 1.3 years.

E

Exposure

Stratification into Transcatheter Tricuspid Valve Replacement (TTVR) eligibility groups based on TRISCEND II pivotal trial criteria (Group 2: symptomatic NYHA II-IV without exclusion criteria; Group 3: symptomatic NYHA II-IV with ≥1 exclusion criterion).

C

Comparator

Group 1 (asymptomatic patients with NYHA functional class I).

O

Outcome

Composite of all-cause death or heart failure (HF) hospitalizationcomposite

Main Result

Hazard Ratio: 2.88 (95% CI 2.16–3.84)

p-value: p=<0.001

Applying TTVR pivotal-trial eligibility criteria to real-world patients with secondary severe TR provides an effective disease-stage framework that identifies a graded risk of death or heart failure hospitalization.

Limitations

Retrospective observational design cannot establish causality or treatment effects
Doppler-derived pulmonary artery systolic pressure (PASP) is less reliable in severe TR with a large regurgitant orifice
Generalizability is limited because the cohort consists solely of patients from three Japanese centers
Severe TR was identified by color Doppler jet area rather than vena contracta width
Eligibility criteria were adapted and limited to items determinable from imaging and laboratory data
Relatively short median follow-up of 1.3 years
Retrospective observational study where group classification does not reflect treatment decisions
Doppler-derived PASP is less reliable in severe TR with a large regurgitant orifice, potentially underestimating coupling
Cohort is based on 3 Japanese centers, limiting generalizability to populations with different ethnicity or healthcare systems

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Symptomatic TTVR-ineligible patients face higher adjusted event risk; hypothesis-generating for trial eligibility criteria as prognostic framework in secondary severe TR.

Abstract

Background: Transcatheter tricuspid valve replacement (TTVR) has expanded the treatment options for secondary severe tricuspid regurgitation (TR). We examined whether pivotal-trial eligibility criteria for TTVR stratify prognosis in a real-world cohort.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kusunose et al. (2026) conducted a cohort in Secondary severe tricuspid regurgitation (n=1,062). TTVR eligibility classification (symptomatic status and TRISCEND II trial exclusion criteria) vs. Group 1 (asymptomatic / NYHA Class I) was evaluated on Composite of all-cause death or heart failure hospitalization (HR 2.88, 95% CI 2.16-3.84, p=<0.001).

synapsesocial.com/papers/6acae64a082e6266f39bf500 https://doi.org/10.1253/circrep.cr-26-0300

View Full Paper

Ask AI

Bookmark

Share

Transcatheter Tricuspid Valve Replacement Eligibility as a Disease-Stage Framework for Prognostic Stratification in Secondary Severe Tricuspid Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transcatheter Tricuspid Valve Replacement Eligibility as a Disease-Stage Framework for Prognostic Stratification in Secondary Severe Tricuspid Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading