• Anaemia
• Right heart Failure
• Transcatheter edge-to-edge repair
• Tricuspid regurgitation
• Valvular heart disease

Background. Anaemia and tricuspid regurgitation (TR) are common in patients with heart failure (HF) and are both associated with poor prognosis. In recent years, transcatheter treatment strategies have been developed as safer options for high-risk surgical patients with severe TR. However, the impact of anaemia on post-procedural outcomes and its effect on the haemodynamic profile of patients with TR remain poorly understood.
Aim. Our aim was to assess the clinical and instrumental characteristics, haemodynamic profile, and post-procedural outcomes in patients with anaemia and significant TR undergoing transcatheter edge-to-edge repair (T-TEER)
Methods. Patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) who underwent T-TEER for significant TR between 2016 and 2023 were included. The main analysis included patients with available haemoglobin (Hb) data, and all-cause mortality was defined as the primary endpoint. A sub-analysis was performed in the subgroup of patients with complete haemodynamic data assessed via right heart catheterization (RHC).
Results. Among a total of 2,291 patients (median age 80 years; IQR, interquartile range 76 – 83 years, 53% female), Hb <11 g/dL was associated with a higher burden of right HF symptoms, increased prevalence of renal dysfunction, adverse right heart remodelling (P<0.05 for all), and a high-risk profile according to the TRISCORE (odds ratio: 2.03; 95% confidence interval: 1.5 – 2.07). The haemodynamic impact of anaemia was investigated in 744 patients with complete RHC data, revealing a profile characterized by pulmonary and systemic hypercirculatory congestion and impaired right ventricular-pulmonary arterial coupling (p<0.05 for both). At 4-year follow-up, patients with Hb <11 g/dL had significantly higher all-cause mortality (66% vs. 44%; p<0.001) compared to those with Hb ≥ 11 g/dL, even after adjustment for confounders (HR: 1.84; 95% CI: 1.38–2.46).
Conclusions. In patients with significant TR undergoing T–TEER, anaemia reflects more advanced disease progression, including renal dysfunction, adverse right heart remodeling, and hypercirculatory congestion, and is associated with reduced post-procedural survival.