Prognostic Value of NYHA Functional Class in Tricuspid Valve Transcatheter Edge-to-Edge Repair

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BACKGROUND: In patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR), NYHA functional class guides assessment, but real-world data on its prognostic value and determinants of symptomatic response remain limited. OBJECTIVES: The objective of the study was to assess the prognostic value of baseline NYHA functional class and identify correlates of NYHA functional class trajectories after T-TEER. METHODS: A total of 3,467 patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) undergoing T-TEER were analyzed. Baseline NYHA functional class was related to survival and heart failure hospitalization. In patients with paired NYHA functional class assessments, correlates of improvement and worsening were evaluated using prespecified multivariable logistic regression. RESULTS: Among 3,424 patients with available baseline NYHA functional class (43 excluded [1.2%]), the median follow-up was 460 days (IQR: 146-856 days). Kaplan-Meier curves demonstrated separation by baseline NYHA functional class for overall and heart failure hospitalization-free survival (both P < 0.001). Two-year mortality was 28.4% (619/3,424; 95% CI: 26.4%-30.4%). In the complete-case Cox cohort (n = 2,185; 63.8%), higher baseline NYHA functional class was associated with 2-year mortality (HR: 1.8 per 1-class increase; 95% CI: 1.5-2.1; P < 0.001). In 1,974 of 3,424 patients (57.7%) with paired NYHA functional class data, NYHA functional classes I/II increased from 16.4% (323/1,974) to 59.4% (1,173/1,974) at follow-up. Improvement was associated with lower body mass index, higher left ventricular ejection fraction, and less residual TR, whereas worsening was associated with lower tricuspid annular plane systolic excursion/systolic pulmonary artery pressure and more residual TR. CONCLUSIONS: In the large real-world EuroTR cohort, baseline NYHA functional class is a strong, independent predictor of 2-year mortality. Symptom trajectories were associated with body mass index, left ventricular ejection fraction, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, and residual TR.

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