AIMS Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR. METHODS AND RESULTS A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) ≥50 mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175-402) days. iPHT+ patients were at higher preoperative risk (P < 0.01), had more severe symptoms (P = 0.01), higher N-terminal pro-B-type natriuretic peptide levels (P < 0.01), more impaired right ventricular (RV) function (P < 0.01), and afterload corrected RV function (P < 0.01). Procedural TTVR success was similar in iPHT+ and iPHT- patients (84 vs. 84%, P = 0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT- carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25-6.37), P < 0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT- patients (P = 0.48). In patients with isolated tricuspid procedure (n = 131) a discordant iPHT+/ePHT- diagnosis and an impaired afterload corrected RV function (P < 0.01 for both) were independent predictors for the occurrence of the combined endpoint. CONCLUSION The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR.

中文翻译：

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严重三尖瓣关闭不全肺动脉高压的临床特征、诊断和风险分层以及经导管三尖瓣修复术的意义

AIMS 肺动脉高压 (PHT) 患者通常被排除在三尖瓣反流 (TR) 的手术治疗之外。使用 MitraClip™ 技术的经导管三尖瓣修复 (TTVR) 是这些患者的新治疗选择。我们旨在评估 PHT 在严重 TR 中的作用及其对 TTVR 的影响。方法和结果 共有 243 名患者在两个中心接受了 TTVR。121 名患者被分组为 iPHT+ [侵入性收缩期肺动脉压 (PAP) ≥ 50 mmHg]。根据超声心动图 PAP (ePHT) 对患者进行类似的分层。在 330 天（四分位距 175-402）天的随访期间，对合并临床终点（死亡、心力衰竭住院和再干预）的发生进行了调查。iPHT+ 患者术前风险较高（P < 0.01），有更严重的症状 (P = 0.01)、更高的 N 端前 B 型利钠肽水平 (P < 0.01)、更受损的右心室 (RV) 功能 (P < 0.01) 和后负荷矫正 RV 功能 (P < 0.01）。iPHT+ 和 iPHT- 患者的手术 TTVR 成功率相似（84 对 84%，P = 0.99）。检测 iPHT 的超声心动图诊断准确度仅为 55%。在随访期间，35% 的患者达到了联合临床终点。iPHT+/ePHT- 的不一致诊断对联合临床终点的风险最高 [HR 3.76 (CI 2.25-6.37), P < 0.01]，而 iPHT+/ePHT+ 患者从联合终点的无生存时间与iPHT- 患者（P = 0.48）。在接受孤立性三尖瓣手术的患者 (n = 131) 中，不一致的 iPHT+/ePHT- 诊断和受损的后负荷校正 RV 功能（两者 P < 0.01）是联合终点发生的独立预测因素。结论 严重 TR 中 PHT 的不一致超声心动图和侵入性诊断可预测 TTVR 后的结果。