Invasive Hemodynamics and Risk Stratification in T-TEER: Moving Beyond ESC Thresholds - EuroTR Registry Insights
Bibliographic record
Abstract
BACKGROUND: Right heart catheterization plays a pivotal role in the preprocedural evaluation of patients considered for transcatheter tricuspid valve edge-to-edge repair. This study aimed to explore the potential impact of hemodynamic parameters obtained through right heart catheterization on patient-centered outcomes. METHODS: This study represents a subanalysis from the multicenter EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation). Patients with invasive hemodynamic data who underwent isolated transcatheter tricuspid valve edge-to-edge repair for significant tricuspid regurgitation were included. Outcomes of interest were a composite of 2-year all-cause death or hospitalization for heart failure (HFH) and a patient-centered composite of 6-month all-cause mortality, HFH, New York Heart Association class IV/worsening New York Heart Association class compared with baseline. Secondary outcome included postprocedural New York Heart Association class improvement. RESULTS: Seven hundred and eleven patients were included in the analysis. Two-year survival free from death and HFH was 63%. Optimal prognostic thresholds identified for death and HFH at 2 years were: mean pulmonary artery pressure≥32 mm Hg, pulmonary capillary wedge pressure (PCWP)≥20 mm Hg, and pulmonary vascular resistance≥5 wood units (WU). The early patient-centered composite outcome occurred in 25% of cases. PCWP≥20 mm Hg was independently associated with an early clinical deterioration (hazard ratio, 2.77 [95% CI, 1.47–5.28]; P <0.001) and with 2-year death/HFH (hazard ratio, 1.75 [95% CI, 1.03–3.02]; P =0.04). No invasive parameter was associated with residual tricuspid regurgitation ≥3+. New York Heart Association class improved significantly throughout the follow-up ( P <0.001), although patients with elevated mean pulmonary artery pressure ( P =0.04) or PCWP ( P <0.01) experienced less symptomatic benefit. CONCLUSIONS: In patients undergoing transcatheter tricuspid valve edge-to-edge repair, invasive hemodynamics—especially elevated PCWP—are independently associated with early patient-centered outcomes and late adverse clinical events. Despite overall improvement of the functional status and no impact on residual tricuspid regurgitation, patients with higher mean pulmonary artery pressure or PCWP benefit less. These findings support the role of comprehensive right heart catheterization in preprocedural risk stratification. REGISTRATION: URL: https://clinicaltrials.gov ; Unique identifier: NCT06307262.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".