Gut Microbial Metabolites and Intestinal Permeability in Patients With Severe Tricuspid Regurgitation Undergoing Transcatheter Tricuspid Valve Intervention (INTEGRITY)

November 8, 2026 updated by: Muhammed Gerçek, Heart and Diabetes Center North-Rhine Westfalia

MicrobIal Metabolites and Gut Leakiness assessmeNT in Patients With sevEre Tricuspid reGuRgItation Undergoing Transcatheter Tricuspid Valve inTervention: a Multidimensional analYsis (INTEGRITY-Trial)

Emerging evidence highlights a bidirectional gut-heart axis, particularly relevant in patients with right heart failure. Elevated right atrial pressures and systemic congestion may impair intestinal perfusion and compromise epithelial integrity, leading to increased gut permeability ("leaky gut") and translocation of microbial products. These processes can trigger systemic inflammation and exacerbate cardiac dysfunction. Alterations in the gut microbiome-collectively referred to as dysbiosis-have also been linked to heart failure pathogenesis. However, the role of intestinal barrier dysfunction and microbial signatures in patients with severe tricuspid regurgitation (TR) remains largely unexplored.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

150

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Germany
    • North Rhine-Westphalia
      • Bad Oeynhausen, North Rhine-Westphalia, Germany, 32545
        • Recruiting
        • Herz- und Diabeteszentrum NRW

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • • Patients with functional tricuspid regurgitation (TR) who were evaluated for transcatheter tricuspid valve intervention

    • Written informed consent in accordance with Good Clinical Practice (GCP) and local legislation
    • Patients undergoing PFO closure without any other known comorbidities will serve as control group

Exclusion Criteria:

  • • Previous tricuspid valve repair or replacement

    • Echocardiographic evaluation not available or not suitable for analysis at baseline
    • Key information from patients (e.g. NYHA, TR grade) not available
    • Known allergy or intolerance against the studied device
    • Persons held in an institution by legal or official order

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Basic Science
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: TTVI Cohort

Patients with severe functional tricuspid regurgitation undergoing transcatheter tricuspid valve intervention (TTVI) as part of routine clinical care. The decision to perform TTVI is made independently of study participation. Patients undergo longitudinal assessment of gut microbial metabolites, intestinal permeability, and clinical parameters.
Procedure: transcatheter tricuspid valve intervention

transcatheter tricuspid valve intervention
Active Comparator: PFO Control Cohort

relevant comorbidities or heart failure. The decision to perform PFO closure is made independently of study participation. This cohort serves as a reference group for the assessment of gut microbial metabolite profiles and intestinal permeability.
Procedure: PFO Control Cohort

Patent Foramen Ovale (PFO) Closure

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Gut Microbial Metabolite Plasma Levels
Time Frame: Baseline (prior to intervention) and 6 months post-intervention (180 ± 14 days)

Change in plasma concentrations of gut microbial metabolites from baseline to 6 months after intervention, assessed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).
Baseline (prior to intervention) and 6 months post-intervention (180 ± 14 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Plasma Levels of Gut Microbial Metabolites at 30 Days
Time Frame: Baseline and 30 days post-intervention

Changes in plasma concentrations of gut microbial metabolites from baseline to 30 days after intervention, quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
Baseline and 30 days post-intervention
Change in Intestinal Permeability at 6 Months
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Changes in intestinal permeability from baseline to 6 months after intervention, assessed using a differential sugar absorption test with lactulose, rhamnose, and sucrose.
Baseline and 6 months post-intervention (180 ± 14 days)
Moderate-to-Severe or Severe Tricuspid Regurgitation at 30 Days
Time Frame: 30 days post-intervention

Number of participants with moderate-to-severe or severe TR assessed by transthoracic echocardiography.
30 days post-intervention
Moderate-to-Severe or Severe Tricuspid Regurgitation at 6 Months
Time Frame: 6 months post-intervention (180 ± 14 days)

Number of participants with moderate-to-severe or severe TR assessed by transthoracic echocardiography.
6 months post-intervention (180 ± 14 days)
All-Cause Mortality
Time Frame: From intervention up to 6 months post-intervention

Number of participants who die from any cause during the follow-up period.
From intervention up to 6 months post-intervention
Heart Failure Rehospitalization
Time Frame: From intervention up to 6 months post-intervention

Number of participants experiencing at least one rehospitalization due to worsening heart failure during the follow-up period.
From intervention up to 6 months post-intervention
Change in New York Heart Association (NYHA) Functional Class
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in NYHA functional class from baseline to 6 months after intervention. NYHA functional class ranges from I (no limitation of physical activity) to IV (symptoms at rest). A lower class indicates better functional status.
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Score
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in health-related quality of life assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) from baseline to 6 months after intervention. Scores range from 0 to 100, with higher scores indicating better health status.
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Serum N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Levels
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in serum NT-proBNP concentration from baseline to 6 months after intervention, assessed using laboratory blood analysis.
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Right Ventricular Basal Diameter
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in right ventricular basal diameter from baseline to 6 months after intervention, assessed by transthoracic echocardiography. Measurements are expressed in millimeters (mm).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Right Ventricular Fractional Area Change (RV FAC)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in right ventricular fractional area change from baseline to 6 months after intervention, assessed by transthoracic echocardiography as a measure of right ventricular systolic function. Measurements are expressed as percentages (%).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Right Ventricular Global Longitudinal Strain (RV GLS)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in right ventricular global longitudinal strain from baseline to 6 months after intervention, assessed by transthoracic echocardiography using speckle-tracking analysis. Measurements are expressed as percentages (%).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Tricuspid Annular Plane Systolic Excursion (TAPSE)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in tricuspid annular plane systolic excursion from baseline to 6 months after intervention, assessed by transthoracic echocardiography as a measure of right ventricular longitudinal systolic function. Measurements are expressed in millimeters (mm).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Estimated Systolic Pulmonary Artery Pressure (sPAP)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in estimated systolic pulmonary artery pressure from baseline to 6 months after intervention, assessed by transthoracic echocardiography using the tricuspid regurgitation jet pressure gradient and estimated central venous pressure. Measurements are expressed in millimeters of mercury (mmHg).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Left Ventricular Ejection Fraction (LVEF)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in left ventricular ejection fraction from baseline to 6 months after intervention, assessed by transthoracic echocardiography using the biplane Simpson method. Measurements are expressed as percentages (%).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Left Ventricular End-Systolic Volume (LVESV)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in left ventricular end-systolic volume from baseline to 6 months after intervention, assessed by transthoracic echocardiography. Measurements are expressed in milliliters (mL).
Baseline and 6 months post-intervention (180 ± 14 days)
Change in Left Ventricular End-Diastolic Volume (LVEDV)
Time Frame: Baseline and 6 months post-intervention (180 ± 14 days)

Change in left ventricular end-diastolic volume from baseline to 6 months after intervention, assessed by transthoracic echocardiography. Measurements are expressed in milliliters (mL).
Baseline and 6 months post-intervention (180 ± 14 days)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Heart and Diabetes Center North-Rhine Westfalia

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 1, 2025

Primary Completion (Estimated)

June 1, 2029

Study Completion (Estimated)

June 1, 2029

Study Registration Dates

First Submitted

August 11, 2025

First Submitted That Met QC Criteria

November 8, 2026

First Posted (Actual)

November 12, 2026

Study Record Updates

Last Update Posted (Actual)

November 12, 2026

Last Update Submitted That Met QC Criteria

November 8, 2026

Last Verified

November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HDZ-KA_0525_INTEGRITY

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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