{"id":"5ed0809e24a6","type":"article","url":"https://hartvaat.nl/2026/05/05/expanded-bij-73-verbetert-tricuspidalisinsufficientie-binnen-30-dagen-na-m-teer-/","title":"EXPANDed: bij 73% verbetert tricuspidalisinsufficiëntie binnen 30 dagen na M-TEER — zonder directe TR-interventie","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["gedilateerde-cardiomyopathie","mitraclip","tricuspidalisinsufficiëntie"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag108","source_url":"https://doi.org/10.1093/eschf/xvag108","authors":["Rodrigo Estevez-Loureiro","Mark J Ricciardi","Wolfgang Rottbauer","Matthew J Price","Philip Raake","Mathew Williams","Federico M Asch","Jose L Zamorano","Melody Dong","Kelli Peterman","Evelio Rodriguez","Saibal Kar","Ralph Stephan von Bardeleben","Francesco Maisano"],"significance":7,"published":"2026-06-26","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"Pooled analysis of the EXPAND and EXPAND G4 studies in 160 patients with mitral and tricuspid regurgitation who underwent mitral transcatheter edge-to-edge repair (M-TEER, MitraClip) and received NO direct TR intervention. Echo assessment was by independent core lab. At 30 days, 73% (n=116) improved to ≤moderate TR; 28% (n=44) remained ≥severe. The ≤moderate TR group had less atrial fibrillation (68% vs 89%, p=0.009), slightly lower LVEF (49% vs 56%, p=0.07), and larger LV dimensions (LVEDV 137.5 vs 107.9 mL, p=0.01). TR reduction persisted at 1 year in 86% of the ≤moderate group; 45% of the ≥severe group improved later. Significantly greater NYHA and KCCQ-OS improvements in the ≤moderate group. 1-year mortality was numerically lower with ≤moderate TR (12.4% vs 22.3%; HR 1.92; p=0.16). LV dilation and lower LVEF predicted TR improvement — relevant for selecting patients who may not need an additional TR procedure.","created":"2026-07-03T10:33:07Z","updated":"2026-07-03T18:39:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pooled analyse van de EXPAND- en EXPAND G4-studies bij 160 patiënten met mitralis- en tricuspidalisinsufficiëntie die mitraal transcatheter edge-to-edge repair (M-TEER, MitraClip) ondergingen en GEEN directe TR-interventie kregen. Echocardiografische beoordeling door onafhankelijk corelab. Op 30 dagen verbeterde 73% (n=116) naar ≤matige TR; 28% (n=44) bleef ≥ernstig. De ≤matige TR-groep had minder atriumfibrilleren (68% vs 89%, p=0,009), iets lagere LVEF (49% vs 56%, p=0,07) en grotere LV-dimensies (LVEDV 137,5 vs 107,9 mL, p=0,01). TR-reductie hield na 1 jaar stand bij 86% van de ≤matige groep; 45% van de ≥ernstig-groep verbeterde alsnog. Significante en grotere verbetering van NYHA-klasse en KCCQ-OS-score in de ≤matige groep. 1-jaars sterfte numeriek lager bij ≤matige TR (12,4% vs 22,3%; HR 1,92; p=0,16). LV-dilatatie en lagere LVEF voorspelden TR-verbetering — relevant voor selectie van patiënten die mogelijk geen aanvullende TR-ingreep nodig hebben.","abstract_original":"BACKGROUND: Transcatheter therapies offer new treatment options for patients with both mitral regurgitation (MR) and tricuspid regurgitation (TR). However, the optimal treatment pathway in patients with combined MR and TR is not completely understood. AIMS: This analysis evaluated the natural TR progression after mitral transcatheter edge-to-edge repair (MTEER) with the MitraClip System in patients with MR and TR from the EXPANDed studies. METHODS: EXPANDed is a pooled cohort from the EXPAND and EXPAND G4 studies. This study includes patients who had severe TR, achieved procedural success with MTEER, and received no direct TR intervention. Echocardiographic assessments were performed independently by echo core lab. Baseline characteristics, 1-year outcomes, and associations with TR improvement were reported based on 30-day TR severity following MTEER. RESULTS: Of those with evaluable TR data at 30 days (N = 160), 73% (N = 116) improved to ≤moderate TR, while 28% (N = 44) had ≥severe TR. The ≤moderate TR group had a lower prevalence of atrial fibrillation (68% vs 89%, P = .009), numerically lower LV ejection fraction (49% vs 56%, P = .07), and larger LV dimensions (LVEDV: 137.5 ± 73.4 vs 107.9 ± 44.8 ml, P = .01). TR reduction was sustained in 86% of ≤moderate TR patients, while 45% of ≥severe TR patients improved to ≤moderate at 1 year. In the ≤moderate TR group, significant and larger improvements in NYHA functional class (P < .0001) and KCCQ-OS score (Δ = + 30.6 ± 25.7, P < .0001) were observed through 1 year. One-year mortality was numerically lower in the ≤moderate TR group (12.4% vs 22.3%) though not statistically significant (HR = 1.92 [.77, 4.79], P = .16). Lower LVEF and larger baseline LV size were associated with TR improvement post-MTEER. CONCLUSIONS: Early TR improvement to ≤moderate was observed in almost 3/4 of the population and was associated with significant symptomatic relief. Patients with both severe MR and TR, particularly those with LV dilation, may experience TR improvement following MTEER."}