Durability of benefit after transcatheter tricuspid valve intervention: insights from actigraphy.

AIMS: Tricuspid regurgitation (TR) is associated with high mortality, morbidity and reduced physical capacity. This study was designed to examine the long-term impact of transcatheter tricuspid valve intervention (TTVI) on physical activity by using the method of actigraphy. METHODS AND RESULTS: Overall, we prospectively included 128 heart failure patients with severe TR (median age 79 years, 48% female) who were scheduled for TTVI. Patients were equipped with activity tracking devices for 1 week before TTVI, and again at 1-6 months and 1 year after TTVI. We compared continuous physical activity (CPA), defined as the mean number of steps/day with New York Heart Association class, quality of life assessments, and 6-min walk distance (all p <0.01). TTVI reduced TR to grade ≤2+ in 94% of patients. Median (interquartile range [IQR]) CPA at baseline was 3108 (1350-4959) steps/day, which increased by 31.4% to 3958 (1823-5657) steps/day at 1-6 months and 4080 (2293-6514) steps/day at 1 year after TTVI (p <0.001 for both comparisons). The impact of TTVI was significantly higher in advanced heart failure patients with low baseline activity (baseline CPA <1350 steps/day; 1-year CPA increase: +121.3%; p <0.001), when compared to moderate activity patients (baseline CPA 1350-4959 steps/day; 1-year CPA increase: +27.5%; p <0.01) or high activity patients (baseline CPA >4959 steps/day; 1-year CPA change: +2.6%; p = 0.39). CONCLUSION: One-week actigraphy demonstrates durable improvement of physical activity after TTVI. Fragile chronic heart failure patients with very low baseline activity, as determined by actigraphy in this study, significantly benefit from transcatheter intervention and should not be excluded from TTVI.

Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure.

OBJECTIVES: This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality. BACKGROUND: Severe tricuspid regurgitation (TR) is associated with high mortality. TTVR effectively alleviates heart failure symptoms, but comprehensive hemodynamic characterization of patients undergoing TTVR is currently lacking. METHODS: This international, multicenter study included 236 patients undergoing TTVR. Data from clinical assessment, echocardiography, intraprocedural right heart catheterization, and noninvasive cardiac output measurement were analyzed. Hemodynamic predictors for mortality were identified using linear Cox regression analysis and were used for stratification of patients with subsequent analysis of survival time. RESULTS: Patients (median age 78 years, 53% women) were symptomatic (89% in New York Heart Association functional class III or IV) because of severe TR (grade ≥3+ in 100%). TTVR significantly reduced TR at discharge (grade ≥3+ in 16%; p < 0.001), with a corresponding 19% reduction of the right atrial v wave (21 mm Hg vs. 16 mm Hg; p < 0.001) and an improvement in cardiac output (from 3.5 to 4.0 l/min; p < 0.01). Invasive mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, and right ventricular stroke work were significant predictors of 1-year mortality (p < 0.05 for all). Hemodynamic stratification by mean pulmonary artery pressure and transpulmonary gradient best predicted 1-year survival (p < 0.001). Although patients with pre-capillary dominant pulmonary hypertension showed an unfavorable prognosis (1-year survival 38%), patients without or with post-capillary pulmonary hypertension had favorable outcome (1-year survival 92% or 78%, respectively). CONCLUSIONS: Invasive assessment of cardiopulmonary hemodynamic status predicts survival after TTVR. Invasive hemodynamic characterization may help identify patients profiting most from TTVR.