Advanced Imaging Assessment of the Impact of Tricuspid Regurgitation on Cardiac Remodeling (JACC January 2025-2)-Article: Advanced Imaging Assessment of the Impact of Tricuspid Regurgitation on Cardiac Remodeling

Article: Advanced Imaging Assessment of the Impact of Tricuspid Regurgitation on Cardiac Remodeling

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The TRILUMINATE Pivotal Imaging Substudy explores the impact of tricuspid regurgitation (TR) on cardiac remodeling using advanced imaging techniques in patients with symptomatic severe TR. This randomized controlled trial assessed the efficacy of the TriClip transcatheter device compared to medical therapy. Advanced imaging modalities, including cardiac magnetic resonance (CMR) and 4D computed tomography (4D-CT), were employed to measure changes in right heart remodeling at baseline, 30 days, and 1-year follow-up.<br /><br />Results included data from 69 participants (31 TriClip, 38 control). After 30 days, the TriClip group showed significant reductions in TR volume (70% reduction, P < 0.0001) and in right ventricular end-diastolic volume (12% reduction, P = 0.001). The reduction in TR volume was found to be strongly correlated with reductions in right ventricular volume, highlighting a significant association between TR reduction and cardiac remodeling (r = 0.90, P < 0.0001). These remodeling effects were sustained through 1-year follow-up in participants receiving TriClip therapy, in contrast to no meaningful changes observed in those receiving medical therapy alone.<br /><br />This study concludes that TriClip significantly reduces TR and promotes beneficial cardiac remodeling. The extent of remodeling correlates with the degree of TR reduction, enhancing forward flow in the right ventricle. Overall, advanced imaging substantiated the physiological impact of the TriClip device. The prognostic implications of these findings are to be further evaluated during extended follow-up, shedding light on the long-term benefits of TR reduction with TriClip therapy.

Keywords

TRILUMINATE Pivotal Imaging Substudy

tricuspid regurgitation

cardiac remodeling

TriClip transcatheter device

advanced imaging techniques

cardiac magnetic resonance

4D computed tomography

right ventricular volume

randomized controlled trial

prognostic implications