Prognostic value and reversibility of liver stiffness in patients undergoing tricuspid transcatheter edge-to-edge valve repair

Abstract Introduction Liver stiffness (LS) assessed by elastography is correlated with right heart failure (RHF) and the severity of tricuspid regurgitation (TR). Although clinical signs of liver disease have been associated with worse outcomes after transcatheter edge-to-edge tricuspid repair (T-TEER), the predictive value of LS remains unknown. Additionally, the impact of T-TEER on liver function and the reversibility of LF has not been well established. Purpose The aim of the present study was to determine the reversibility of LS in the short and long-term after T-TEER; and its prognostic value. Methods We prospectively analyzed 34 patients who underwent T-TEER (Triclip 68%, Pascal 32%) as a treatment for severe TR between 2022 and 2025 at our center. Liver elastography was performed using a Philips Affinity ultrasound system before the procedure, at 1 month, and at 1 year post-implantation. Fibrosis stages were classified according to ECHOSENS™ cut-off values: F0–F1: ≤6.9 kPa; F2: 7.0–8.6 kPa; F3: 8.7–10.2 kPa; F4: ≥10.3 kPa. Results We included 34 patients with a mean age of 74±11 years, 62% women, and a mean TRI-SCORE of 4.0±1.8. TR etiology was atrial in 21%, ventricular in 47%, pacemaker lead-induced in 3%, and primary in 29%. The median follow-up was 12 months (IQR 5.5–26). Baseline LS was 8.9±3.3 kPa, corresponding to stage F3. Procedural success was achieved in 83% of patients and was associated with improvement in LS at 1-month follow-up. During follow-up, there were 3 cardiovascular deaths and 5 heart failure admissions. Correction of TR by T-TEER was associated with a significant improvement in liver fibrosis at 1 year (from 8.9±3.3 kPa to 6.7±2.2 kPa; p=0.013), with an average stage reduction from F2 to F1 (p=0.003) (Figure 1A). Before the procedure, 53% of patients had F0/F1 fibrosis, increasing to 70% at 1 year (Figure 1B). In univariate analysis, only bilirubin levels, female sex, and TRI-SCORE