Left atrial remodelling and diastolic unloading after transcatheter tricuspid repair
Abstract
Background and Aims: Severe tricuspid regurgitation (TR) alters ventricular interaction and left-sided filling dynamics. However, the longitudinal effects of transcatheter tricuspid edge-to-edge repair (T-TEER) on left atrial (LA) remodelling and diastolic physiology remain poorly characterized. We aimed to evaluate longitudinal changes in LA structure, function, and diastolic haemodynamics following T-TEER. Methods: We studied 125 consecutive patients undergoing T-TEER within the TRI-FR trial and registry (median age 78 [73–81] years; 60.8% women; 73.6% atrial fibrillation). Comprehensive echocardiography was performed at baseline, pre-discharge, and at 6 and 12 months. Longitudinal changes in LA volume index (LAVI), peak atrial longitudinal strain (PALS), E/e′ ratio, LA stiffness index (LASI), and forward flow indices were analysed using linear mixed-effects models. Results: Left atrial volume index decreased immediately after T-TEER (estimated change −8.1 ml/m2; 95% CI −14.6 to −1.6; adjusted P = .033), but this reverse remodelling was not sustained at 12 months. In contrast, LA reservoir function deteriorated early and remained impaired throughout follow-up [PALS −1.2%; 95% confidence interval (CI) −2.0 to −0.3; adjusted P = .029]. Estimated LV filling pressure increased acutely (E/e′ + 3.26; 95% CI 2.34–4.18; adjusted P < .001), while LASI remained elevated at 12 months (ratio 1.22; 95% CI 1.05–1.42; adjusted P = .016). Stroke volume index and cardiac index did not change significantly over time (P = .969 and P = .562, respectively). Early mitral regurgitation worsening occurred in 20% of patients but was transient and unrelated to changes in diastolic or forward-flow parameters. Conclusions: Transcatheter tricuspid edge-to-edge repair induces immediate anatomical LA unloading but does not restore LA mechanical function. Despite early reductions in LA volume, filling pressure surrogates increased, LA stiffness remained elevated, and forward flow did not improve. These findings demonstrate a dissociation between structural and functional remodelling after TR correction and highlight the importance of serial assessment of LA mechanics and diastolic physiology following T-TEER.
Related
- Tricuspid Regurgitation in the Era of Transcatheter Intervention: Beyond Multivalvular Complexity Toward Hemodynamic Phenotyping
- Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry
- Left Ventricular Function and Atrial Remodeling Shape Outcomes After Mitral-Transcatheter Edge-to-Edge Repair
- Effect of Clover versus Zipping on Annular Geometry and Dynamics in Tricuspid Edge-to-Edge Repair
- No Strings Attached: Predicting Tricuspid Valve Deformation Without In Vivo Chordal Geometry
BibTeX
@article{rasmeehirun2026left,
title = {{Left atrial remodelling and diastolic unloading after transcatheter tricuspid repair}},
author = {Prayuth Rasmeehirun and Andromahi Zygouri and Paul-Calin Craciun and Guillaume L'Official and Vincent Auffret and Guillaume Leurent and Erwan Donal},
journal = {ESC Heart Failure},
year = {2026},
month = jul,
doi = {10.1093/eschf/xvag198},
url = {https://hal.science/hal-05753155v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Left atrial remodelling and diastolic unloading after transcatheter tricuspid repair
AU - Prayuth Rasmeehirun
AU - Andromahi Zygouri
AU - Paul-Calin Craciun
AU - Guillaume L'Official
AU - Vincent Auffret
AU - Guillaume Leurent
AU - Erwan Donal
PY - 2026
DA - 2026/07/16
JO - ESC Heart Failure
DO - 10.1093/eschf/xvag198
UR - https://hal.science/hal-05753155v1
AB - Background and Aims: Severe tricuspid regurgitation (TR) alters ventricular interaction and left-sided filling dynamics. However, the longitudinal effects of transcatheter tricuspid edge-to-edge repair (T-TEER) on left atrial (LA) remodelling and diastolic physiology remain poorly characterized. We aimed to evaluate longitudinal changes in LA structure, function, and diastolic haemodynamics following T-TEER. Methods: We studied 125 consecutive patients undergoing T-TEER within the TRI-FR trial and registry (median age 78 [73–81] years; 60.8% women; 73.6% atrial fibrillation). Comprehensive echocardiography was performed at baseline, pre-discharge, and at 6 and 12 months. Longitudinal changes in LA volume index (LAVI), peak atrial longitudinal strain (PALS), E/e′ ratio, LA stiffness index (LASI), and forward flow indices were analysed using linear mixed-effects models. Results: Left atrial volume index decreased immediately after T-TEER (estimated change −8.1 ml/m2; 95% CI −14.6 to −1.6; adjusted P = .033), but this reverse remodelling was not sustained at 12 months. In contrast, LA reservoir function deteriorated early and remained impaired throughout follow-up [PALS −1.2%; 95% confidence interval (CI) −2.0 to −0.3; adjusted P = .029]. Estimated LV filling pressure increased acutely (E/e′ + 3.26; 95% CI 2.34–4.18; adjusted P < .001), while LASI remained elevated at 12 months (ratio 1.22; 95% CI 1.05–1.42; adjusted P = .016). Stroke volume index and cardiac index did not change significantly over time (P = .969 and P = .562, respectively). Early mitral regurgitation worsening occurred in 20% of patients but was transient and unrelated to changes in diastolic or forward-flow parameters. Conclusions: Transcatheter tricuspid edge-to-edge repair induces immediate anatomical LA unloading but does not restore LA mechanical function. Despite early reductions in LA volume, filling pressure surrogates increased, LA stiffness remained elevated, and forward flow did not improve. These findings demonstrate a dissociation between structural and functional remodelling after TR correction and highlight the importance of serial assessment of LA mechanics and diastolic physiology following T-TEER.
SN - 2055-5822
ER -