AimsConventional parameters of right ventricular (RV) function are load‐dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure, but its prognostic value in patients undergoing tricuspid transcatheter edge‐to‐edge repair (T‐TEER) has not been investigated so far.Methods and resultsFrom the EuroTR registry (2019 to 2022), patients with complete datasets and a minimum of 2‐years of follow‐up were included. RV functional parameters (i.e. tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], TAPSE/systolic pulmonary arterial pressure [sPAP]), as well as a echocardiographic RV load adaptation index (Dandel's index) were assessed and their predictive value in terms of all‐cause mortality evaluated using logistic multivariate logistic regression. The majority of the 364 patients had secondary TR (96%) and were severely symptomatic (New York Heart Association class ≥III; 92%). At 2‐year follow‐up, 36% of patients had died. Functional RV parameters (TAPSE: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.84; FAC: HR 0.73, 95% CI 0.59–0.91), coupling index (TAPSE/sPAP: HR 0.8, 95% CI 0.65–0.99) and Dandel's index (HR 0.67, 95% CI 0.53–0.85) were all associated with mortality at 2 years in univariable analyses. In a multivariate logistic regression model, the Dandel's index maintained its predictive value (p < 0.001), along with TAPSE and absence of signs of right heart failure, with an optimal threshold of 20.5 determined by the receiver‐operating characteristic analysis. This threshold also successfully predicted cardiac hospital readmission. A multivariate analysis was conducted to identify parameters linked to RV function and predicting clinical outcomes.ConclusionAssessment of the RV capacity to adjust for changes in loading conditions predicted mortality in patients with severe symptomatic TR undergoing T‐TEER. The use of a multiparametric approach including the Dandel's index to assess RV function had an incremental value for the stratification of patients into subgroups with different prognosis.

中文翻译：

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蒲德尔指数在接受三尖瓣经导管边对边修复术患者中的预后价值


目的右心室 （RV） 功能的常规参数是负荷依赖性的，因此不能准确反映相关三尖瓣反流 （TR） 患者的收缩力。在心力衰竭患者中，已使用 Dandel's 指数表征了 RV 对负荷的适应性，但迄今为止尚未研究其在接受三尖瓣经导管边缘对边缘修复 （T-TEER） 患者中的预后价值。方法和结果从 EuroTR 登记处（2019 年至 2022 年），包括数据集完整且至少随访 2 年的患者。评估 RV 功能参数 （即 三尖瓣环平面收缩偏移 [TAPSE]、面积变化分数 [FAC]、TAPSE/收缩期肺动脉压 [sPAP]），以及超声心动图 RV 负荷适应指数 （Dandel's index），并使用 logistic 多变量 logistic 回归评估其对全因死亡率的预测价值。364 例患者中大多数患有继发性 TR （96%） 并且症状严重 （纽约心脏协会 ≥III 级;92%）。在 2 年随访中，36% 的患者死亡。功能性 RV 参数 （TAPSE：风险比 [HR] 0.72,95% 置信区间 [CI] 0.62-0.84;FAC：在单变量分析中，HR 0.73,95% CI 0.59-0.91）、耦合指数 （TAPSE/sPAP：HR 0.8,95% CI 0.65-0.99）和丹德尔指数 （HR 0.67,95% CI 0.53-0.85） 均与 2 年死亡率相关。在多变量 logistic 回归模型中，Dandel's 指数保持其预测值 （p < 0.001），以及 TAPSE 和无右心衰竭迹象，最佳阈值为 20.5由受试者工作特征分析确定。该阈值还成功预测了心脏病医院再入院率。 进行多变量分析以确定与 RV 功能相关的参数并预测临床结果。结论评估 RV 调整负荷条件变化的能力可预测接受 T-TEER 的严重症状性 TR 患者的死亡率。使用包括 Dandel 指数在内的多参数方法评估 RV 功能对于将患者分层为具有不同预后亚组具有增量价值。