LAUSR

The presence of significant tricuspid regurgitation (TR) is directly associated with morbidity and mortality,1 and there is a graded association of more severe TR with worse prognosis.2 Previously, it has been speculated that TR was rather a secondary sign than a serious pathology in itself, and the attention was drawn toward the treatment of underlying conditions, e.g. heart valve disease and heart failure.3–5 Recent data have challenged the concept of only targeting the left heart by showing that a reduction of TR, particularly by transcatheter tricuspid valve edge-to-edge repair (TTVR), may reduce mortality and rehospitalization.6 Regrettably, it is unclear how to best define those patients who benefit most from TTVR. This question, however, is of paramount importance as significant TR is a common condition, affecting more than 2% of individuals over the age of 75, and has recently even been referred to as a “public health crisis”.7 In this issue of the Journal, Besler et al.8 present the results of their single-centre experience with TTVR and how procedural success was related to changes in nutritional status at follow-up. Nutritional status before and after treatment was assessed by the Mini Nutritional Assessment (MNA) questionnaire. An MNA score increase of at least 1 point was considered as an improvement. The high prevalence of patients already malnourished (15%) or at risk for malnutrition (79%) prior to the intervention, as well as the reported 6-month mortality of 28% in the overall cohort illustrate the frailty of patients who are currently treated at reference centres for TTVR. Procedural success, defined as a TR reduction of at least one grade at 1-month follow-up was achieved in the majority of patients. Also, MNA scores mostly improved after 1 month, and better scores were associated with better results in quality of life and functional capacity as assessed by 6-min walking distance. Improvements in MNA scores were accompanied by improved