Right ventricular functional and echocardiographic evaluation in patients under follow-up after T-TEER

Introduction Severe tricuspid regurgitation is associated with reduced functional capacity and potential right ventricular impairment. In elderly or high-surgical-risk patients, transcatheter tricuspid valve repair with TriClip represents an important therapeutic option. Exercise stress echocardiography combined with the six-minute walk test (6MWT) may help assess functional and haemodynamic response after treatment. Methods Thirty-two patients with severe tricuspid regurgitation treated with TriClip were analysed. In 2025, all patients underwent exercise stress echocardiography with concurrent 6MWT. Clinical, functional, and echocardiographic parameters were collected, including heart rate, left ventricular ejection fraction, pulmonary artery systolic pressure (PAPs), tricuspid regurgitation velocity (TRV), TAPSE, TAPSE/PAPs ratio, 6MWT distance, NYHA class, Borg score, and maximum workload. In 2026, a one-year follow-up was performed. Given the limited number of paired observations, longitudinal analyses were descriptive. Results The cohort was elderly, with a mean age of 79 years (range 63–94). At baseline, heart rate increased from 71 ± 11 bpm at rest to 118 ± 15 bpm at peak stress. Left ventricular systolic function was preserved, with an ejection fraction of 55 ± 1% at rest and 65 ± 2% after stress. Mean PAPs increased from 26 ± 7 mmHg at rest to 37 ± 6 mmHg at peak exercise, with corresponding TRV values of 2.46 ± 0.47 m/s and 2.86 ± 0.37 m/s. Mean TAPSE was 20 ± 3 mm. Mean 6MWT distance was 384 ± 70 m, with a Borg score of 12 ± 2, median NYHA class II, and maximum workload of 78 ± 8 W. At follow-up, only 3 of 32 patients completed a comparable reassessment; 6 patients were unable to complete the stress protocol and were classified as clinically worsened, while 23 were lost to follow-up. Among the three patients with paired data, three different trajectories were observed: clinical and echocardiographic stability; functional improvement with increased TAPSE and 6MWT distance; and deterioration with rising pulmonary pressures, reduced TAPSE, and a decline in the TAPSE/PAPs ratio, consistent with right ventricular–pulmonary arterial uncoupling. Conclusions In patients with severe tricuspid regurgitation treated with TriClip, exercise stress echocardiography combined with 6MWT may provide useful information on functional and haemodynamic response after treatment. One-year follow-up showed heterogeneous trajectories, although the high proportion of patients who were not reassessed or were lost to follow-up limits cohort-level conclusions. The TAPSE/PAPs ratio may represent a useful parameter for monitoring right ventricular–pulmonary arterial coupling after treatment.