Right ventricular-arterial coupling as a predictor of poor prognosis after tricuspid transcatheter edge-to-edge repair

Abstract Introduction Right ventricular function and its coupling to Pulmonary Circulation (Ventricular Arterial Coupling -VAC-) has shown prognostic value in patients with tricuspid regurgitation (TR). Purpose Our aim was to evaluate the evolution and prognostic significance of VAC in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER). Methods We prospectively analyzed 62 patients who underwent T-TEER (Mitraclip 10%, Triclip 60%, Pascal 30%) between 2018 and 2025 at our center. All patients had a right heart catheterization before the procedure to rule out precapillary pulmonary hypertension. Follow-up was performed at 1 month and 1 year after the procedure. Results We included 62 patients with a mean age of 73.7±9.7 years, 65% women, with an average EuroScore II of 5.4±3.7% and TRI-SCORE of 4.2±2.1. Average Left Ventricle ejection fraction was 59±7%. The median follow-up was 12 months (IQR 6–26). Procedural success was 86%; there were 6 cases of partial detachment, 3 of which were successfully treated with an additional device. During follow-up, there were 6 cardiovascular deaths and 16 heart failure admissions of 10 patients. Baseline VAC (TAPSE/PASP ratio) was within the normal range and showed a trend toward improvement over time. This improvement was more pronounced in patients who did not experience clinical events (Fig 1A). RV systolic function was preserved and remained stable after T-TEER, while systolic pulmonary artery pressure (sPAP) was initially elevated but significantly decreased after the procedure (Fig 1B). Survival analysis showed that a TAPSE/PASP ratio ≤0.39 before T-TEER (cutoff determined by ROC curve) was associated with higher risk of death or heart failure admissions (Log Rank p=0.038) (Fig 1C–D). Those with VAC ≤0.39 had worse baseline characteristics (e.g., higher NYHA class, larger RV size, elevated NT-proBNP, and more diuretic resistance), though none reached statistical significance. Procedural success was similar regardless of baseline VAC (Figure 2. Table). Conclusions Right ventricular coupling provides valuable and more precise information than other RV function parameters for monitoring patients undergoing T-TEER. In our cohort, a VAC value ≤0.39 was associated with a worse prognosis and may help identify patients who need closer follow-up after TR correction.Coupling evolution and KaplanMeier Curve Baseline characteristics and evolution