Echocardiographic Outcomes After Transcatheter Edge-to-Edge Repair in Patients With Isolated Tricuspid Regurgitation: The Tri.Fr Trial (JIMG March 2026)-Article: Echocardiographic Outcomes After Transcatheter Edge-to-Edge Repair in Patients With Isolated Tricuspid Regurgitation: The Tri.Fr Trial

Article: Echocardiographic Outcomes After Transcatheter Edge-to-Edge Repair in Patients With Isolated Tricuspid Regurgitation: The Tri.Fr Trial

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This Tri.Fr trial echocardiographic substudy examined 300 older patients with severe isolated tricuspid regurgitation (TR) randomized to tricuspid transcatheter edge-to-edge repair (T-TEER) plus guideline-directed medical therapy (GDMT) or GDMT alone. At 1 year, T-TEER markedly reduced TR severity: most treated patients improved from massive/torrential TR to moderate or less, while GDMT alone produced little change.<br /><br />Despite better valve reduction, conventional right ventricular (RV) measures did not improve. In fact, several RV systolic indices in the T-TEER group declined slightly over time, including TAPSE, RV fractional area change, and RV free-wall strain. Right atrial volume index and RV–pulmonary artery coupling also showed no significant reverse remodeling in either group.<br /><br />Clinical improvement tracked most strongly with the degree of residual TR reduction. The Packer clinical composite score, Kansas City Cardiomyopathy Questionnaire score, and 6-minute walk distance all improved progressively as TR was reduced more completely. Patients with a better clinical response had lower right atrial volume at 1 year, but they did not differ meaningfully in RV function compared with those who did not improve.<br /><br />Subgroup analyses suggested that the benefit of T-TEER on clinical outcomes was present regardless of baseline right atrial size, but was seen mainly in patients with preserved RV–pulmonary artery coupling (TAPSE/SPAP >0.40).<br /><br />Overall, the study concludes that T-TEER effectively lowers TR severity and improves symptoms and functional status, but has limited impact on standard measures of RV recovery or RV–pulmonary artery coupling. Achieving the best possible TR reduction appears more important for 1-year outcomes than RV functional recovery alone.

Meta Tag

Concept T-TEER

Concept Tricuspid Regurgitation

Concept Guideline-Directed Medical Therapy

Concept Right Ventricular Function

Concept Tricuspid Annular Plane Systolic Excursion

Keywords

tricuspid regurgitation

T-TEER

echocardiographic substudy

right ventricular function

right atrial volume index

RV-pulmonary artery coupling

clinical outcomes

Packer clinical composite score

Kansas City Cardiomyopathy Questionnaire

6-minute walk distance

T-TEER

Tricuspid Regurgitation

Guideline-Directed Medical Therapy

Right Ventricular Function

Tricuspid Annular Plane Systolic Excursion