BACKGROUND Atrial secondary tricuspid regurgitation (A-STR) has been proposed as an important etiologic subentity of secondary tricuspid regurgitation (STR). Patients with A-STR are frequently treated using transcatheter tricuspid valve edge-to-edge repair (T-TEER). OBJECTIVES The aims of this study were to evaluate prevalence and outcomes following T-TEER for severe A-STR and to compare the results to patients with nonatrial STR. METHODS The study included patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry who underwent T-TEER for STR from 2016 until 2022. A-STR was defined as a ratio of end-systolic right atrial area to right ventricular area ≥1.5 in the presence of preserved right ventricular function (tricuspid annular plane systolic excursion >17 mm). The primary study endpoint was 2-year survival free from heart failure hospitalization. Secondary endpoints were 2-year survival, tricuspid regurgitation (TR) reduction at discharge and 1-year follow-up as well as changes in NYHA functional class. RESULTS This study included 641 patients (50% women) with a mean age of 79 ± 7 years. The overall prevalence of A-STR was 31% (n = 196). A-STR was associated with a higher prevalence of atrial fibrillation, less frequent comorbidities, better biventricular function, less leaflet tenting, and larger atria. Although TR severity was comparable at baseline, patients with A-STR had more effective procedural TR reduction (TR ≤2+ in 86.9% vs 80.4% of those with nonatrial STR; P = 0.005). Although NYHA functional class improved in both STR subetiologies, the symptomatic burden was lower in patients with A-STR at the latest available follow-up (NYHA functional class ≥III in 46% of patients with nonatrial STR vs 38% in those with A-STR; P = 0.033). Beyond that, A-STR was associated with higher 2-year survival rates free from heart failure hospitalization (66.3% [Q1-Q3: 58.2%-75.5%] vs 47.5% [Q1-Q3: 41.7%-54.7%] in patients with nonatrial STR; P < 0.001). Median survival follow-up was 379 days [Q1-Q3: 155-697 days]. CONCLUSIONS A-STR is a common phenotype of STR and is associated with effective TR reduction and symptomatic reduction after T-TEER.

中文翻译：

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心房继发性三尖瓣反流：深入了解 EuroTR 登记处。


背景 心房继发性三尖瓣反流 （A-STR） 已被提议作为继发性三尖瓣反流 （STR） 的重要病因学亚实体。A-STR 患者经常使用经导管三尖瓣边缘到边缘修复术 （T-TEER） 进行治疗。目的 本研究的目的是评估重度 A-STR 的 T-TEER 患病率和结果，并将结果与非房 STR 患者进行比较。方法 该研究包括来自 EuroTR （欧洲三尖瓣反流经导管修复登记处） 登记处的患者，他们在 2016 年至 2022 年期间接受了 STR 的 T-TEER。A-STR 定义为在右心室功能保留的情况下，收缩末期右心房面积与右心室面积的比值 ≥1.5 （三尖瓣环平面收缩偏移 >17 mm）。主要研究终点是 2 年无心力衰竭住院生存率。次要终点是 2 年生存率、出院时三尖瓣反流 （TR） 减少和 1 年随访以及 NYHA 功能分级的变化。结果 本研究包括 641 名患者 （50% 为女性），平均年龄为 79 ± 7 岁。A-STR 的总体患病率为 31% （n = 196）。A-STR 与心房颤动患病率较高、合并症频率较低、双心室功能较好、瓣叶帐篷较少和心房较大相关。尽管基线时 TR 严重程度相当，但 A-STR 患者的程序性 TR 降低更有效（86.9% 的 TR ≤2+ vs 非房 STR 患者的 80.4%;P = 0.005）。 尽管 NYHA 功能分级在两种 STR 亚病因中都有所改善，但在最新的随访中，A-STR 患者的症状负担较低（46% 的非房 STR 患者的 NYHA 功能分级为 ≥III，而 A-STR 患者为 38%;P = 0.033）。除此之外，A-STR 与较高的心力衰竭住院 2 年生存率相关 （66.3% [Q1-Q3： 58.2%-75.5%] vs 47.5% [Q1-Q3： 41.7%-54.7%] 在非房 STR 患者中;P < 0.001）。中位生存期随访为 379 天 [Q1-Q3： 155-697 天]。结论 A-STR 是 STR 的常见表型，与 T-TEER 后 TR 的有效减少和症状减轻相关。