AimsThe aim of this study was to assess the pathophysiological implications of severe tricuspid regurgitation (TR) in patients with heart failure with preserved ejection fraction (HFpEF) by using tricuspid transcatheter edge‐to‐edge repair (T‐TEER) as a model of right ventricular (RV) volume overload relief.Methods and resultsThis prospective interventional single arm trial (NCT04782908) included patients with invasively diagnosed HFpEF. The following parameters were prospectively assessed before and after T‐TEER: left ventricular (LV) diastolic properties by invasive pressure–volume loop recordings; biventricular time–volume curves and function as well as septal curvature by cardiac magnetic resonance imaging; strain analyses for timing of septal motion. Overall, 20 patients (median age 78, interquartile range [IQR] 72–83 years, 65% female) were included. T‐TEER reduced TR by a median of 2 (of 5) grades (IQR 2–1). T‐TEER increased LV stroke volume and LV end‐diastolic volume (LVEDV) (p < 0.001), without increasing LV end‐diastolic pressure (LVEDP) (p = 0.094), consequently diastolic function improved with a reduction in LVEDP/LVEDV (p = 0.001) and a rightward shift of the end‐diastolic pressure–volume relationship. The increase in LVEDV correlated with a decrease in RV end‐diastolic volume (p < 0.001) and LV transmural pressure increased (p = 0.028). Secondary to a decrease in early RV filling, improvements in early LV filling were observed, correlating with an alleviation of leftwards bowing of the septum (p < 0.01, respectively).ConclusionDiastolic LV properties in patients with HFpEF and severe TR are importantly determined by ventricular interaction in the setting of RV volume overload. T‐TEER reduces RV volume overload and improves biventricular interaction and physiology.

中文翻译：

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三尖瓣反流和右心室容量超负荷对射血分数保留的心力衰竭患者的影响

目的本研究的目的是通过使用三尖瓣经导管边对边修复术（T-TEER）作为右心衰竭模型，评估严重三尖瓣反流（TR）对射血分数保留的心力衰竭（HFpEF）患者的病理生理学影响。方法和结果这项前瞻性介入单臂试验 (NCT04782908) 包括侵入性诊断的 HFpEF 患者。在 T-TEER 之前和之后前瞻性评估了以下参数： 通过有创压力-容量环记录来评估左心室 (LV) 舒张特性；通过心脏磁共振成像显示双心室时间-体积曲线和功能以及间隔曲率；隔膜运动时间的应变分析。总体而言，纳入了 20 名患者（中位年龄 78 岁，四分位距 [IQR] 72-83 岁，65% 为女性）。T-TEER 将 TR 降低了 2 个（共 5 个）等级的中位数（IQR 2-1）。T-TEER 增加左心室每搏输出量和左心室舒张末期容积 (LVEDV)（p< 0.001)，不增加左室舒张末压 (LVEDP)（p= 0.094），因此舒张功能随着 LVEDP/LVEDV 的降低而改善（p= 0.001）以及舒张末期压力-容量关系的右移。LVEDV 的增加与 RV 舒张末期容积的减少相关（p< 0.001) 且 LV 跨壁压增加 (p= 0.028）。继早期右心室充盈减少之后，观察到早期左心室充盈改善，这与隔膜向左弯曲的减轻相关。p分别 < 0.01）。 结论 HFpEF 和严重 TR 患者的舒张期 LV 特性在 RV 容量超负荷情况下主要由心室相互作用决定。T-TEER 可减少 RV 容量超负荷并改善双心室相互作用和生理机能。