Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial

Abstract

Background: Prior studies suggest tricuspid regurgitation (TR) diminishes/resolves following mitral valve surgery and thus do not require treatment and may not influence outcomes. Purpose: We sought to evaluate the change in TR (ΔTR) and its association with outcomes after transcatheter edge‐to‐edge repair (TEER) compared with guideline‐directed medical therapy (GDMT) in the COAPT trial. Methods: Patients from the COAPT trial with echo core lab TR assessment at baseline and 30‐day follow‐up (n = 504) were included and divided into 2 groups: those whose TR worsened (ΔTR‐INC) and those with no change or improvement in TR (ΔTR‐SAME/DEC). Two‐year composite endpoints of death or heart failure hospitalization (HFH) and the individual components were analyzed, after excluding events occurring within the first 30 days. Results: ΔTR‐SAME/DEC occurred in 430 pts (228 TEER, 202 GDMT) while ΔTR‐INC was noted in 74 pts (38 TEER, 36 GDMT) (Figure 1A). From 30 days to 2 years, ΔTR‐INC pts had a higher rate of the composite outcome of death or HFH compared with ΔTR‐SAME/DEC (p = 0.006, Figure 1B). Both 2‐year death (HR 1.52, 95% CI 1.01‐2.27; p = 0.04) and HFH (HR 1.52, 95% CI 1.04‐2.22; p = 0.03) were associated with ΔTR‐INC. Assessed by treatment group (Figure 1C and 1D), the relationship between ΔTR‐INC and composite death or HFH was significant in GDMT alone pts (HR 1.86, 95% CI 1.21‐2.86) but not in TEER pts (HR 1.33, 95% CI 0.79‐2.23), although interaction testing demonstrated consistency between the two treatments (Pint = 0.31). Conclusions: Worsening TR at 30 days occurred in ∼15% of pts in the COAPT trial whether they were treated with TEER or GDMT alone. DTRINC was associated with increased death and HFH during 2‐year follow‐up.