BACKGROUND Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has been reported to be associated with right ventricular reverse remodeling (RVRR). Data on the temporal evolution of this phenomenon are scarce. OBJECTIVES The aim of this study was to evaluate RVRR over the course of 2-year follow-up after T-TEER using sequential 3-dimensional echocardiograms (3DE). METHODS The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1 month, 6 months, as well as 1 and 2 years. The 3DE evaluation included right ventricular volumes (right ventricular end-diastolic volume [RVEDV3D]; right ventricular end-systolic volume [RVESV3D]), right ventricular ejection fraction (RVEF3D), and RV longitudinal strain of the free wall and the septum. RESULTS The study included 231 patients (median age 82 [IQR: 79-86] years, 48% women). We observed a biphasic pattern of RVRR following T-TEER consisting of early RV volume unloading (phase 1, reduced RVEDV3D) and later structural remodeling (phase 2, reduced RVESV3D). Whereas RVEDV3D was significantly reduced early after the procedure (-9.7% from baseline to discharge; P < 0.001), RVESV3D remained unchanged at 1-month follow-up. Reduction in RVESV3D was observed at 6-month follow-up for the first time (-5.4% from baseline to 6-month follow-up; P < 0.001). Reduction in both RVEDV3D and RVESV3D peaked at 1-year follow-up and remained stable until 2 years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF3D at baseline 42.2% ± 8.9%, discharge 31.1% ± 9.4%, 2-year follow-up 41.6% ± 8.9%). The 3D RV longitudinal strain of the septum and 3D RV longitudinal strain of the free wall developed analogously. CONCLUSIONS RVRR following T-TEER occurs in 2 stages and involves early RV unloading (reduction in RVEDV3D) and later structural RVRR (reduction in RVESV3D) with an improvement in RVEF.

中文翻译：

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三尖瓣经导管边对边修复后的双相右心室反向重塑。


背景 据报道，经导管三尖瓣边缘到边缘修复 （T-TEER） 与右心室反向重塑 （RVRR） 有关。关于这种现象的时间演变的数据很少。目的 本研究的目的是使用序贯 3 维超声心动图 （3DE） 评估 T-TEER 后 2 年随访过程中的 RVRR。方法 该研究包括基线和出院时具有可用 3DE 的 T-TEER 患者。进一步的随访安排在 1 个月、 6 个月以及 1 年和 2 年。3DE 评估包括右心室容积 [右心室舒张末期容积 [RVEDV3D];右心室收缩末期容积 [RVESV3D]）、右心室射血分数 （RVEF3D） 以及游离壁和隔膜的 RV 纵向应变。结果 该研究包括 231 名患者 （中位年龄 82 [IQR： 79-86] 岁，48% 为女性）。我们观察到 T-TEER 后 RVRR 的双相模式，包括早期 RV 体积卸载 （第 1 阶段，降低 RVEDV3D） 和后期结构重塑 （阶段 2，降低RVESV3D）。而手术后早期 RVEDV3D 显著降低（从基线到出院 -9.7%;P < 0.001），RVESV3D 在 1 个月的随访中保持不变。在 6 个月的随访中首次观察到 RVESV3D 的减少 （从基线到 6 个月随访 -5.4%;P < 0.001）。RVEDV3D 和 RVESV3D 的减少在 1 年随访时达到峰值，并一直保持稳定，直到 T-TEER 后 2 年。T-TEER 后 RV 功能早期下降，并在随访过程中逐渐增加 （基线 RVEF3D 为 42.2% ± 8.9%，出院率为 31.1% ± 9.4%，2 年随访 41.6% ± 8.9%）。隔膜的 3D RV 纵向应变和自由壁的 3D RV 纵向应变发展相似。 结论 T-TEER 后的 RVRR 分 2 个阶段发生，涉及早期 RV 卸载 （RVEDV3D减少） 和后期结构性 RVRR （RVESV3D减少） 伴 RVEF 改善。