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    Interventional procedure overview of transcatheter tricuspid valve implantation for tricuspid regurgitation

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    Outcome measures

    The main outcomes included procedural success, reduction in TR, functional outcomes, quality of life, echocardiographic outcomes, mortality and complications. Some of the measures used are detailed in the following paragraphs.

    TR severity grading

    TR severity is typically graded on a 5-grade scale based on echocardiographic parameters:

    • Mild (1+)

    • Moderate (2+)

    • Severe (3+)

    • Massive (4+)

    • Torrential (5+)

    New York Heart Association (NYHA) functional class

    The NYHA functional class is used to classify heart failure according to severity of symptoms and limitation of physical activity:

    • Class 1 - no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, breathlessness, or palpitations.

    • Class 2 - slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

    • Class 3 - marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

    • Class 4 - unable to carry out any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken discomfort is increased.

    Kansas City Cardiomyopathy Questionnaire

    The Kansas City Cardiomyopathy Questionnaire is a 23-item self-administered questionnaire that measures the patient's perception of their health status, including heart failure symptoms, impact on physical and social function, and how their heart failure impacts their quality of life within a 2-week recall period. Scores are scaled from 0 to 100, where higher scores represent better health status.

    Echocardiographic outcomes

    Most studies reported echocardiographic measurements, including linear dimensions and volumes. Other outcomes are described in the following paragraphs.

    LVEF is the ratio of blood ejected during systole (stroke volume) to blood in the ventricle at the end of diastole (end-diastolic volume). A normal range is typically between 50 and 70%. Values below 30% are considered a severe reduction.

    TAPSE is a measure of RV function that evaluates RV longitudinal systolic performance. TAPSE is measured using TTE and the systolic displacement of the annulus is recorded in millimetres. A lower TAPSE value, typically less than 17 mm, suggests impaired RV function and is often seen in conditions such as pulmonary hypertension and heart failure.

    RV fractional area change reflects the percentage change in the RV chamber area between end-diastole and end-systole, providing an estimate of the RV's ability to contract. A normal value is 35% or higher.