Abstract
OBJECTIVE: To evaluate the predictive value of echocardiographic findings for postoperative tricuspid regurgitation (TR) worsening after transcatheter atrial septal defect (ASD) with patent foramen ovale (PFO) closure using domestic occluders, and to develop a dynamic risk prediction model to guide clinical decision-making. METHODS: This retrospective cohort study included 109 patients undergoing ASD/PFO closure with occluders (manufactured domestically in China) at a single center (between January 2018 and May 2024). Participants were stratified into an observation group (TR worsening ≥ 1 grade, n = 26) and a control group (stable TR, n = 83). Echocardiographic data - including tricuspid annular diameter, coaptation height, and occluder positional deviation - were assessed preoperatively, immediately postoperatively, and at 1-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: Compared to controls, the observation group (n = 26) exhibited significantly greater tricuspid annular dilation (mean Δdiameter: 3.2 ± 0.8 mm vs 0.9 ± 0.4 mm; P < 0.001) and occluder positional deviation (4.1 ± 1.2 mm vs 1.8 ± 0.6 mm; P < 0.001). Multivariate analysis identified Δtricuspid annular diameter (OR = 1.32 per 1-mm increase, 95% CI: 1.12-1.56; P < 0.001) and occluder deviation (OR = 2.41 per 1-mm increase, 95% CI: 1.68-3.45; P < 0.001) as independent predictors of TR worsening. The combined predictive model demonstrated superior discrimination (AUC = 0.802, 95% CI: 0.742-0.862; sensitivity = 76.9%, specificity = 81.3%) outperforming their individual application (P < 0.001). Subgroup analysis showed consistent predictive performance across occluder types (P(interaction) = 0.87). CONCLUSION: Dynamic tricuspid annular dilation and occluder malposition erre independent risk factors for postoperative TR progression. The echocardiography-based predictive model enhances risk stratification and may inform intraprocedural adjustments and postoperative surveillance.