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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Eur Heart J 2023; 44:4508-4532. [PMID: 37793121 PMCID: PMC10645050 DOI: 10.1093/eurheartj/ehad653] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland
- University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York,USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York,USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York,USA
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York,USA
- University of California-San Diego, San Diego, California, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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52
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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53
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Färber G, Marx J, Scherag A, Saqer I, Diab M, Sponholz C, Doenst T. Risk stratification for isolated tricuspid valve surgery assisted using the Model for End-Stage Liver Disease score. J Thorac Cardiovasc Surg 2023; 166:1433-1441.e1. [PMID: 35431033 DOI: 10.1016/j.jtcvs.2021.11.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Isolated tricuspid valve surgery is perceived as high-risk. This perception is nurtured by patients who often present with substantial liver dysfunction, which is inappropriately reflected in current surgical risk scores (eg, the Society of Thoracic Surgeons [STS] score has no specific tricuspid model). The Model for End-Stage Liver Disease (MELD) has was developed as a measure for the severity of liver dysfunction. We report scores and outcomes for our patient population. METHODS We calculated STS, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (ESII), and MELD scores for all of our patients who received isolated tricuspid valve surgery between 2011 and 2020 (n = 157). We determined the MELD score, stratified patients into 3 groups (MELD <10: low, n = 53; 10 to <20: intermediate, n = 78; ≥20: high, n = 26) and describe associated outcomes. RESULTS Patients were 72 ± 10 years old and 43% were male. Mean STS score was 4.9 ± 3.5% and ESII was 7.2 ± 6.6%. Mortality was 8.9% at 30 days and 65% at latest follow-up (95% CI, 51%-76%). Median follow-up was 4.4 years (range, 0-9.7 years). Although ESII and STS score accurately predicted 30-day mortality at low MELD scores (observed to expected [O/E] for ESII score = 0.8 and O/E for STS score = 1.0) and intermediate MELD (O/E for ESII score = 0.7, O/E for STS score = 1.0), mortality was underestimated at high MELD (O/E for ESII score = 3.0, O/E for STS score = 4.7). This subgroup also had higher incidence of new-onset hemodialysis. Besides MELD category, recent congestive heart failure, endocarditis, and hemodialysis were also associated with 30-day mortality. CONCLUSIONS For isolated tricuspid valve regurgitation, classic surgical risk stratification with STS or ESII scores failed to predict perioperative mortality if there was evidence of severe liver dysfunction. Preoperative MELD assessment might be useful to assist in proper risk assessment for isolated tricuspid valve surgery.
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Affiliation(s)
- Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Jonas Marx
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ibrahim Saqer
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Ann Thorac Surg 2023; 116:908-932. [PMID: 37804270 DOI: 10.1016/j.athoracsur.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Baim Institute of Clinical Research, Boston, Massachusetts
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York; University of California-San Diego, San Diego, California
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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55
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Seligman H, Vora AN, Haroian NQ, Puri R, Heng EL, Smith RD, Latib A, Makkar R, Sorajja P, Leon MB, Ahmad Y. The Current Landscape of Transcatheter Tricuspid Valve Intervention. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101201. [PMID: 39131057 PMCID: PMC11307702 DOI: 10.1016/j.jscai.2023.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 08/13/2024]
Abstract
Tricuspid regurgitation (TR) is common, and its prevalence increases with age. It was previously estimated that there are 1.6 million patients in the United States with moderate or worse TR, and more contemporary data suggest the age-adjusted prevalence of TR is 0.55%. Increasing TR severity is associated with an adverse prognosis independent of the pulmonary artery pressure and the degree of right heart failure. In heart failure with reduced ejection fraction, survival is significantly worsened when moderate or severe TR is present. The mainstay of therapy has traditionally been surgery, but outcomes are poor. There has been increasing attention on the potential role of transcatheter interventions for TR. Numerous platforms are in developmental evolution, which broadly fall into 3 categories: valve replacement, valve repair (subdivided into annular, leaflet, and chordal platforms), and caval valve implantation. In this review, we examine all these strategies and devices, including guidance on how to appropriately select patients who can benefit from intervention.
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Affiliation(s)
- Henry Seligman
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Amit N. Vora
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Noah Q. Haroian
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ee Ling Heng
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Robert D. Smith
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Azeem Latib
- Department of Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Martin B. Leon
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
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Xu H, Li W, Lee APW, Wu S, Husanova F, Wu B, Mou Y, Gu Y, Chen M, Tao T, Zhang Y, Zheng J, Yang A, Yuan S, Wang Q, Ni Y, Ma L. 30-Day Outcomes of Transcatheter Tricuspid Annuloplasty With the K-Clip System: A Single-Center, Observational Study. JACC. ADVANCES 2023; 2:100671. [PMID: 38938712 PMCID: PMC11198610 DOI: 10.1016/j.jacadv.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 06/29/2024]
Abstract
Background Surgery for isolated functional tricuspid regurgitation (TR) poses a high risk. Several transcatheter approaches are being evaluated for the treatment of such patients. The K-Clip system is a percutaneous approach designed for functional TR; however, its utility remains unknown. Objectives This study aimed to report the 30-day echocardiographic and clinical outcomes with the K-Clip system for severe TR, including changes in TR severity and NYHA functional class. Methods Transcatheter tricuspid valve annuloplasty was performed in 39 patients with intermediate or high surgical risk who underwent the K-Clip system. The right internal jugular vein procedure was performed with annuloplasty guided by fluoroscopy and echocardiography. The primary outcomes were clinical success and all-cause mortality at the 30-day follow-up. Results The K-Clip was successfully implanted in all cases, with 1 to 3 devices deployed. At the 30-day follow-up, none of the patients had died. TR severity was reduced by at least one grade in all patients. There were no severe procedural or 30-day adverse events, except for 1 new pacemaker implantation. The proportion of NYHA class III-IV patients decreased from 79.5% to 5.1%, and the ascites disappeared. The 6-minute walk distance increased by 78 m (P < 0.05), and the Kansas City Cardiomyopathy Questionnaire score improved by 11 points (P < 0.05). Conclusions The K-Clip device is practical, safe, and effective for patients with severe TR. A 30-day reduction in TR and enhanced cardiac function and quality of life were associated with transcatheter tricuspid annuloplasty using the K-Clip device, according to short-term follow-up studies. (Confirmatory Clinical Study of Treating Tricuspid Regurgitation With K-Clip TM Transcatheter Annuloplasty System [TriStar]; NCT05173233).
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Affiliation(s)
- Hongfei Xu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Shengjun Wu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Firyuza Husanova
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Bifeng Wu
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yun Mou
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanjia Gu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Miao Chen
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Tingting Tao
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yiran Zhang
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Junnan Zheng
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Anqi Yang
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shuai Yuan
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qing Wang
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
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57
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Venkataramani R, Hershberger A, Choi CH, Ng V, Bhardwaj A, Ramakrishna H. Tricuspid Regurgitation: A Focus on Updated Interventional Anatomy and Pathophysiology. J Cardiothorac Vasc Anesth 2023; 37:2327-2334. [PMID: 37573214 DOI: 10.1053/j.jvca.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Ranjani Venkataramani
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Amy Hershberger
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Christine Heejae Choi
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Victor Ng
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Adarsh Bhardwaj
- Department of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Harish Ramakrishna
- Department of Cardiology, University of California, San Francisco, San Francisco, CA.
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58
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. J Am Coll Cardiol 2023; 82:1711-1735. [PMID: 37804294 DOI: 10.1016/j.jacc.2023.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. https://twitter.com/AnnaSannino198
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. https://twitter.com/PDXHeartValveMD
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York, USA; University of California-San Diego, San Diego, California, USA. https://twitter.com/oribenyehuda
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Forado-Benatar I, Caravaca-Pérez P, Rodriguez-Espinosa D, Guzman-Bofarull J, Cuadrado-Payán E, Moayedi Y, Broseta JJ, Farrero M. Tricuspid regurgitation, right ventricular function, and renal congestion: a cardiorenal triangle. Front Cardiovasc Med 2023; 10:1255503. [PMID: 37859684 PMCID: PMC10583553 DOI: 10.3389/fcvm.2023.1255503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
There is a growing interest in the evaluation of tricuspid regurgitation due to its increasing prevalence and detrimental impact on clinical outcomes. Historically, it has been coined the "forgotten" defect in the field of valvular heart disease due to the lack of effective treatments to improve prognosis. However, the development of percutaneous treatment techniques has led to a new era in its management, with promising results and diminished complication risk. In spite of these advances, a comprehensive exploration of the pathophysiological mechanisms is essential to establish clear indications and optimal timing for medical and percutaneous intervention. This review will address the most important aspects related to the diagnosis, pathophysiology and treatment of tricuspid regurgitation from a cardiorenal perspective, with a special emphasis on the interaction between right ventricular dysfunction and the development of hepatorenal congestion.
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Affiliation(s)
| | | | - Diana Rodriguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Elena Cuadrado-Payán
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic of Barcelona, Barcelona, Spain
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60
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Gröger M, Friedl S, Ouerghemmi D, Tadic M, Bruß E, Felbel D, Paukovitsch M, Schneider LM, Dahme T, Rottbauer W, Markovic S, Keßler M. TRI-SCORE is superior to EuroSCORE II and STS-Score in mortality prediction following transcatheter edge-to-edge tricuspid valve repair. Clin Res Cardiol 2023; 112:1436-1445. [PMID: 37405481 PMCID: PMC10562344 DOI: 10.1007/s00392-023-02246-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The development of transcatheter tricuspid edge-to-edge repair for tricuspid regurgitation is a therapeutic milestone but a specific periprocedural risk assessment tool is lacking. TRI-SCORE has recently been introduced as a dedicated risk score for tricuspid valve surgery. AIMS This study analyzes the predictive performance of TRI-SCORE following transcatheter edge-to-edge tricuspid valve repair. METHODS 180 patients who underwent transcatheter tricuspid valve repair at Ulm University Hospital were consecutively included and stratified into three TRI-SCORE risk groups. The predictive performance of TRI-SCORE was assessed throughout a follow-up period of 30 days and up to 1 year. RESULTS All patients had severe tricuspid regurgitation. Median EuroSCORE II was 6.4% (IQR 3.8-10.1%), median STS-Score 8.1% (IQR 4.6-13.4%) and median TRI-SCORE 6.0 (IQR 4.0-7.0). 64 patients (35.6%) were in the low TRI-SCORE group, 91 (50.6%) in the intermediate and 25 (13.9%) in the high-risk groups. The procedural success rate was 97.8%. 30-day mortality was 0% in the low-risk group, 1.3% in the intermediate-risk and 17.4% in the high-risk groups (p < 0.001). During a median follow-up of 168 days mortality was 0%, 3.8% and 52.2%, respectively (p < 0.001). The predictive performance of TRI-SCORE was excellent (AUC for 30-day mortality: 90.3%, for one-year mortality: 93.1%) and superior to EuroSCORE II (AUC 56.6% and 64.4%, respectively) and STS-Score (AUC 61.0% and 59.0%, respectively). CONCLUSION TRI-SCORE is a valuable tool for prediction of mortality after transcatheter edge-to-edge tricuspid valve repair and its performance is superior to EuroSCORE II and STS-Score. In a monocentric cohort of 180 patients undergoing edge-to-edge tricuspid valve repair TRI-SCORE predicted 30-day and up to one-year mortality more reliably than EuroSCORE II and STS-Score. AUC area under the curve, 95% CI 95% confidence interval.
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Affiliation(s)
- Matthias Gröger
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sophia Friedl
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dhia Ouerghemmi
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Marijana Tadic
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Elene Bruß
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Leonhard M Schneider
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tillman Dahme
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Jia KY, Chen F, Peng Y, Wei JF, He S, Wei X, Tang H, Meng W, Feng Y, Chen M. Multidetector CT-derived tricuspid annulus measurements predict tricuspid regurgitation reduction after transcatheter aortic valve replacement. Clin Radiol 2023; 78:779-788. [PMID: 37574402 DOI: 10.1016/j.crad.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
AIM To use multidetector row computed tomography (MDCT)-derived tricuspid annulus (TA) measurements to identify predictors for tricuspid regurgitation (TR) reduction after transcatheter aortic valve replacement (TAVR), and to investigate the impact of TR change on prognosis. MATERIALS AND METHODS A retrospective, single-centre study was conducted on consecutive patients who underwent TAVR with concomitant baseline mild or more severe TR from April 2012 to April 2022. TA parameters were measured using MDCT. RESULTS The study comprised 266 patients (mean age 74.2 ± 7.6 years, 147 men) and 45.1% had more than one grade of TR reduction at follow-up. Independent predictors of TR reduction at follow-up were distance between TA centroid and antero-septal commissure (odd ratio [OR] 0.776; 95% confidence interval [CI]: 0.672-0.896, p=0.001), baseline TR of moderate or worse (OR 4.599; 95% CI: 2.193-9.648, p<0.001), systolic pulmonary artery pressure (OR 1.018; 95% CI: 1.002-1.035, p=0.027), age (OR 0.955; 95% CI: 0.920-0.993, p=0.019), and pre-existing atrial fibrillation (OR 0.209; 95% CI: 0.101-0.433, p<0.001). Patients without TR reduction had higher rates of rehospitalisation (hazard ratio [HR] 0.642; 95% CI: 0.413-0.998, p=0.049). CONCLUSIONS The MDCT-derived TA parameter was predictive of TR reduction after TAVR. Persistent TR after TAVR was associated with higher rates of rehospitalisation.
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Affiliation(s)
- K-Y Jia
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - F Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - Y Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - J-F Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - S He
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - X Wei
- Department of Cardiology, Section of Cardiac Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - H Tang
- Department of Cardiology, Section of Cardiac Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - W Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
| | - Y Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
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Hinojosa W, Cruz-Utrilla A, Jiménez López-Guarch C, Velázquez-Martín M, Segura de la Cal T, Gómez-Burgueño L, Otero M, López-Gude MJ, Morales R, Cortina-Romero JM, Solís J, Arribas Ynsurriaga F, Escribano-Subías P. Outcome of moderate-severe tricuspid regurgitation after pulmonary endarterectomy or balloon pulmonary angioplasty. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:774-782. [PMID: 37137424 DOI: 10.1016/j.rec.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/02/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of persistent moderate-severe tricuspid regurgitation (TR) in patients with chronic thromboembolic pulmonary hypertension after treatment with pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) is not well defined. This study aimed to analyze the progression and predictors of significant persistent postintervention TR and its prognostic impact. METHODS This single-center observational study included 72 patients undergoing PEA and 20 who completed a BPA program with a previous diagnosis of chronic thromboembolic pulmonary hypertension and moderate-to-severe TR. RESULTS The postintervention prevalence of moderate-to-severe TR was 29%, with no difference between the PEA- or BPA-treated groups (30.6% vs 25% P=.78). Compared with patients with absent-mild postprocedure TR, those with persistent TR had higher mean pulmonary arterial pressure (40.2±1.9 vs 28.5±1.3mmHg P <.001), pulmonary vascular resistance (472 [347-710] vs 282 [196-408] dyn.s/cm5; P <.001), and right atrial area (23.0 [21-31] vs 16.0 [14.0-20.0] P <.001). The variables independently associated with persistent TR were pulmonary vascular resistance> 400 dyn.s/cm5 and postprocedure right atrial area> 22cm2. No preintervention predictors were identified. The variables associated with increased 3-year mortality were residual TR and mean pulmonary arterial pressure> 30mmHg. CONCLUSIONS Residual moderate-to-severe TR following PEA-PBA was associated with persistently high afterload and unfavorable postintervention right chamber remodeling. Moderate-to-severe TR and residual pulmonary hypertension were associated with a worse 3-year prognosis.
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Affiliation(s)
- Williams Hinojosa
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Cruz-Utrilla
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Jiménez López-Guarch
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Maite Velázquez-Martín
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Teresa Segura de la Cal
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Macarena Otero
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Jesús López-Gude
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Morales
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José María Cortina-Romero
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Solís
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Fernando Arribas Ynsurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Escribano-Subías
- Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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63
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Zhu QM, Berry N. Tricuspid Regurgitation: Disease State and Advances in Percutaneous Therapy. Eur Cardiol 2023; 18:e55. [PMID: 37860699 PMCID: PMC10583156 DOI: 10.15420/ecr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 10/21/2023] Open
Abstract
Tricuspid regurgitation (TR) is a relatively common finding. There has been growing recognition of the morbidity and adverse prognosis of severe TR, which affects 1.6 million people in the US. However, symptomatic TR remains undertreated despite emerging therapeutic modalities. In this review, the pathophysiological and epidemiological features of TR are examined and the diagnosis, natural history, and clinical presentation are discussed. An overview of TR therapy is provided, including medical and surgical treatments, as well as novel percutaneous approaches. The currently available studies on percutaneous therapy demonstrate promise for transcatheter valve repair and replacement with favourable clinical outcomes and short-term durability. However, further study is needed.
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Affiliation(s)
- Qiuyu Martin Zhu
- Kaiser Permanente Mid-Atlantic States Internal Medicine Residency Program Gaithersburg, MD, US
| | - Natalia Berry
- Mid-Atlantic Permanente Medical Group McLean, VA, US
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Rommel KP, Besler C, Unterhuber M, Kresoja KP, Noack T, Kister T, Brener MI, Fudim M, Abdel-Wahab M, Leon MB, Thiele H, Burkhoff D, Lurz P. Stressed Blood Volume in Severe Tricuspid Regurgitation: Implications for Transcatheter Treatment. JACC Cardiovasc Interv 2023; 16:2245-2258. [PMID: 37609697 DOI: 10.1016/j.jcin.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Although tricuspid transcatheter edge-to-edge repair (TEER) has been suggested to improve outcomes in patients with tricuspid regurgitation (TR), patients remain at substantial residual risk after the intervention. Total blood volume is divided between the unstressed volume, filling the vascular space, and stressed blood volume (SBV), generating intravascular pressure. SBV is an important mediator of hemodynamic derangements in heart failure and might pose an attractive adjunctive treatment target. OBJECTIVES The aim of this study was to investigate the role of SBV in patients with severe TR and its implications for tricuspid TEER. METHODS In total, 279 patients underwent right heart catheterization prior to TEER. SBV was estimated from hemodynamic variables fit to a comprehensive cardiovascular model. RESULTS Estimated stressed blood volume (eSBV) was associated with obesity, renal and hepatic dysfunction and cardiac remodeling (P < 0.05 for all). Hemodynamically, eSBV correlated with pulmonary artery and cardiac filling pressures as well as right ventricular-pulmonary artery coupling (P < 0.05 for all). After TEER, patients with eSBV greater than the median demonstrated less reduction in right atrial pressures, peripheral edema, and ascites compared with lower eSBV patients (P < 0.05 for all). Higher eSBV was an independent predictor of the occurrence of death and heart failure hospitalization during a median follow-up duration of 618 days (P < 0.05 for all). CONCLUSIONS In patients with severe TR, eSBV is associated with obesity, renal and liver dysfunction, more severe heart failure, attenuated reduction of venous congestion after TEER, and adverse clinical outcomes. Estimation of SBV should be incorporated in future trials in the field to identify patients in need of adjunctive therapies.
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Affiliation(s)
- Karl-Philipp Rommel
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany; Cardiovacular Research Foundation, New York, New York, USA.
| | - Christian Besler
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Tobias Kister
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Michael I Brener
- Cardiovacular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Martin B Leon
- Cardiovacular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Holger Thiele
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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65
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Sala A, Hahn RT, Kodali SK, Mack MJ, Maisano F. Tricuspid Valve Regurgitation: Current Understanding and Novel Treatment Options. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101041. [PMID: 39132395 PMCID: PMC11307688 DOI: 10.1016/j.jscai.2023.101041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 08/13/2024]
Abstract
Managing patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging, with a lack of consensus on when and how to treat it. Tricuspid valve pathology has been disregarded for a very long time because of the established belief that treating left-sided heart diseases would lead to the resolution or significant improvement of TR. Initially considered benign, severe TR has been found to be a strong predictor of prognosis. Despite the increasing prevalence and the disabling nature of this disease, the great majority of patients with clinically significant TR have seldom been considered for structural interventions. Numerous surgical and transcatheter treatment options are now available; however, optimal timing and procedural selection remain crucial aspects influencing outcomes. According to recent evidence in the literature, early referral is associated with good short and long-term outcomes, and various predictors of favorable outcomes following either surgical or transcatheter treatment have been identified. Evaluation by a multidisciplinary heart team with expertise in tricuspid valve disease is of paramount importance to identify adequate treatment for every patient.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rebecca T. Hahn
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Susheel K. Kodali
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael J. Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, Texas
| | - Francesco Maisano
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
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66
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Nishiwaki S, Watanabe S, Yoneda F, Tanaka M, Aizawa T, Yamagami S, Komasa A, Kawaji T, Yoshizawa T, Kohjitani H, Morimoto T, Kimura T, Shizuta S. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1441-1453. [PMID: 36510108 DOI: 10.1007/s10840-022-01410-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated. METHODS We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6-18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up. RESULTS Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0-7.6] cm2 to 2.1 [1.1-3.1] cm2, P < 0.001). Moreover, mitral regurgitation jet area, left atrial area, mitral valve diameter, right ventricular end-diastolic area, right atrial area, and tricuspid valve diameter decreased at follow-up. CONCLUSIONS TR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.
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Affiliation(s)
- Shushi Nishiwaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan.
| | - Fumiya Yoneda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Munekazu Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | | | - Akihiro Komasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Tetsuma Kawaji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hirohiko Kohjitani
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
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Coisne A, Lancellotti P, Habib G, Garbi M, Dahl JS, Barbanti M, Vannan MA, Vassiliou VS, Dudek D, Chioncel O, Waltenberger JL, Johnson VL, De Paulis R, Citro R, Pibarot P. ACC/AHA and ESC/EACTS Guidelines for the Management of Valvular Heart Diseases: JACC Guideline Comparison. J Am Coll Cardiol 2023; 82:721-734. [PMID: 37587584 DOI: 10.1016/j.jacc.2023.05.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 08/18/2023]
Abstract
Valvular heart disease (VHD) is common and poses important challenges from the standpoints of diagnosis and therapeutic management. Clinical practice guidelines have been developed to help health care professionals to overcome these challenges and provide optimal management to patients with VHD. The American College of Cardiology, in collaboration with the American Heart Association, and the European Society of Cardiology, in collaboration with the European Association for Cardio-Thoracic Surgery, recently updated their guidelines on the management of VHD. Although these 2 sets of guidelines are generally concordant, there are some substantial differences between these guidelines, which may have significant implications for clinical practice. This review prepared on behalf of the EuroValve Consortium describes the consistencies and discrepancies between the guidelines and highlights the gaps in these guidelines and the future research perspectives to fill these gaps.
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Affiliation(s)
- Augustin Coisne
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Cardiovascular Research Foundation, New York, New York, USA.
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Aix Marseille University, Marseille, France
| | - Madalina Garbi
- Royal Papworth Hospital, Cambridge University Health Partners, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vassilios S Vassiliou
- Department of Cardiology, Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu,' Bucharest, Romania; University of Medicine Carol Davila, Bucharest, Romania
| | - Johannes L Waltenberger
- University of Muenster, Medical Faculty, Muenster, Germany; Hirslanden Clinic in Park, Zurich, Switzerland
| | | | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
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68
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Gerçek M, Goncharov A, Narang A, Körber ML, Friedrichs KP, Baldridge AS, Meng Z, Puthumana JJ, Davidson LJ, Malaisrie SC, Thomas JD, Rudolph TK, Pfister R, Rudolph V, Davidson CJ. Characterization of Screen Failures Among Patients Evaluated for Transcatheter Tricuspid Valve Repair (TriSelect-Study). JACC Cardiovasc Interv 2023; 16:1579-1589. [PMID: 37438025 DOI: 10.1016/j.jcin.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Transcatheter tricuspid valve repair (TTVr) has significantly expanded treatment options for tricuspid regurgitation (TR). However, a sizeable proportion of patients are still declined for TTVr and little is known about their clinical characteristics and cardiac morphology. OBJECTIVES This study sought to characterize patients who screen fail for TTVr with respect to their clinical characteristics and cardiac morphology. METHODS A total of 547 patients were evaluated for TTVr between January 2016 to December 2021 from 3 centers in the United States and Germany. Clinical records and echocardiographic studies were used to assess medical history and right ventricular (RV) and tricuspid valve (TV) characteristics. RESULTS Median age was 80 (IQR: 74-83) years and 60.0% were female. Over half (58.1%) were accepted for TTVr. Of those who were deemed unsuitable for TTVr (41.9%), the most common exclusion reasons were anatomical criteria (56.8%). In the regression analysis, RV and right atrial size, TV coaptation gap, and tethering area were identified as independent screen failure predictors. Other rejection reasons included clinical futility (17.9%), low symptom burden (12.7%), and technical limitations (12.7%). Most of the excluded patients (71.6%) were managed conservatively with medical therapy, while a small number either proceeded to TV surgery (22.3%) or subsequently became eligible for transcatheter tricuspid valve replacement in later available clinical trials in the United States (6.1%). CONCLUSIONS The majority of TTVr screen failure patients are excluded due to TV, right atrial, and RV enlargement. However, a significant proportion is excluded due to clinical futility. These identifiable anatomical and clinical characteristics emphasize the importance of earlier referral and intervention of TR and the need for continued innovation of Transcatheter tricuspid valve interventions.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Arseniy Goncharov
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L Körber
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Zhiying Meng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jyothy J Puthumana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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69
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Adamo M, Chioncel O, Benson L, Shahim B, Crespo-Leiro MG, Anker SD, Coats AJS, Filippatos G, Lainscak M, McDonagh T, Mebazaa A, Piepoli MF, Rosano GMC, Ruschitzka F, Savarese G, Seferovic P, Shahim A, Popescu BA, Iung B, Volterrani M, Maggioni AP, Metra M, Lund LH. Prevalence, clinical characteristics and outcomes of heart failure patients with or without isolated or combined mitral and tricuspid regurgitation: An analysis from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail 2023; 25:1061-1071. [PMID: 37365841 DOI: 10.1002/ejhf.2929] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
AIM Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum. METHODS AND RESULTS The ESC-HFA EORP HF Long-Term Registry is a prospective, multicentre, observational study including patients with HF and 1-year follow-up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60-0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41-0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36-0.49), and combined MR/TR (OR 0.59; 95% 0.50-0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61-2.33). All-cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR. CONCLUSION In a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Lina Benson
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Bahira Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, INIBIC, UDC, CIBERCV, La Coruna, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, University Hospital Attikon, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - Mitja Lainscak
- Division of Cardiology, Murska Sobota, Murska Sobota and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Alexander Mebazaa
- Department of Anesthesia-Burn-Critical Care, UMR 942 Inserm - MASCOT; University of Paris; APHP Saint Louis Lariboisière University Hospitals, Paris, France
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | | | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Angiza Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Bogdan A Popescu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université Paris Cité, Paris, France
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
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70
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Chioncel O, Adamo M, Nikolaou M, Parissis J, Mebazaa A, Yilmaz MB, Hassager C, Moura B, Bauersachs J, Harjola VP, Antohi EL, Ben-Gal T, Collins SP, Iliescu VA, Abdelhamid M, Čelutkienė J, Adamopoulos S, Lund LH, Cicoira M, Masip J, Skouri H, Gustafsson F, Rakisheva A, Ahrens I, Mortara A, Janowska EA, Almaghraby A, Damman K, Miro O, Huber K, Ristic A, Hill L, Mullens W, Chieffo A, Bartunek J, Paolisso P, Bayes-Genis A, Anker SD, Price S, Filippatos G, Ruschitzka F, Seferovic P, Vidal-Perez R, Vahanian A, Metra M, McDonagh TA, Barbato E, Coats AJS, Rosano GMC. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology. Eur J Heart Fail 2023; 25:1025-1048. [PMID: 37312239 DOI: 10.1002/ejhf.2918] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence-based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear-cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.
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Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maria Nikolaou
- Cardiology Department, General Hospital 'Sismanogleio-Amalia Fleming', Athens, Greece
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandre Mebazaa
- Université Paris Cité, MASCOT Inserm, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France
| | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Moura
- Armed Forces Hospital, Faculty of Medicine of Porto, Porto, Portugal
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben-Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Vlad Anton Iliescu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius; Centre of Innovative Medicine, Vilnius, Lithuania
| | | | - Lars H Lund
- Karolinska Institute, Department of Medicine, and Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | | | - Josep Masip
- Research Direction, Consorci Sanitari Integral, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Hadi Skouri
- Division of Cardiology, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amina Rakisheva
- Scientific and Research Institute of Cardiology and Internal Disease, Almaty, Kazakhstan
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Cologne, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Mortara
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Ewa A Janowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Abdallah Almaghraby
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Oscar Miro
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Kurt Huber
- Medical Faculty, Sigmund Freud University, Vienna, Austria
- 3rd Medical Department, Wilhelminen Hospital, Vienna, Austria
| | - Arsen Ristic
- Department of Cardiology of the University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Alaide Chieffo
- Vita Salute-San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific, Institute, Milan, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Susanna Price
- Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, Zurich, Switzerland
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alec Vahanian
- University Paris Cite, INSERM LVTS U 1148 Bichat, Paris, France
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, London, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Godoy Rivas C, Agarwal V, Tomlinson S, Lebehn M, Kodali S, Hahn RT. Tricuspid Leaflet Gap-Reduction Maneuvers During Transcatheter Tricuspid Valve Repair. JACC Case Rep 2023; 15:101850. [PMID: 37283822 PMCID: PMC10240231 DOI: 10.1016/j.jaccas.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/08/2023]
Abstract
Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has emerged as an option for treating patients with tricuspid regurgitation. Few studies have explored intraprocedural maneuvers to optimize leaflet-grasping T-TEER in order to improve technical success. This case series of 3 patients describes maneuvers that facilitated T-TEER in patients with large coaptation gaps or short leaflet lengths. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Carlos Godoy Rivas
- Address for correspondence: Dr Carlos Godoy Rivas, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, New York 10032, USA. @CGR_MD
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72
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Obayashi Y, Kato T, Yaku H, Morimoto T, Seko Y, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Inoko M, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Ozasa N, Kimura T. Tricuspid regurgitation in elderly patients with acute heart failure: insights from the KCHF registry. ESC Heart Fail 2023; 10:1948-1960. [PMID: 36992608 PMCID: PMC10192228 DOI: 10.1002/ehf2.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS Several studies demonstrated that tricuspid regurgitation (TR) is associated with poor clinical outcomes. However, data on patients with TR who experienced acute heart failure (AHF) remains scarce. The purpose of this study is to evaluate the association between TR and clinical outcomes in patients admitted with AHF, using a large-scale Japanese AHF registry. METHODS AND RESULTS The current study population consisted of 3735 hospitalized patients due to AHF in the Kyoto Congestive Heart Failure (KCHF) registry. TR grades were assessed according to the routine clinical practice at each participating centre. We compared the baseline characteristics and outcomes according to the severity of TR. The primary outcome was all-cause death. The secondary outcome was hospitalization for heart failure (HF). The median age of the entire study population was 80 (interquartile range: 72-86) years. One thousand two hundred five patients (32.3%) had no TR, while mild, moderate, and severe TR was found in 1537 patients (41.2%), 776 patients (20.8%), and 217 patients (5.8%), respectively. Pulmonary hypertension, significant mitral regurgitation, and atrial fibrillation/flutter were strongly associated with the development of moderate/severe of TR, while left ventricular ejection fraction <50% was inversely associated with it. Among 993 patients with moderate/severe TR, the number of patients who underwent surgical intervention for TR within 1 year was only 13 (1.3%). The median follow-up duration was 475 (interquartile range: 365-653) days with 94.0% follow-up at 1 year. As the TR severity increased, the cumulative 1 year incidence of all-cause death and HF admission proportionally increased ([14.8%, 20.3%, 23.4%, 27.0%] and [18.9%, 23.0%, 28.5%, 28.4%] in no, mild, moderate, and severe TR, respectively). Compared with no TR, the adjusted risks of patients with mild, moderate, and severe TR were significant for all-cause death (hazard ratio [95% confidence interval]: 1.20 [1.00-1.43], P = 0.0498, 1.32 [1.07-1.62], P = 0.009, and 1.35 [1.00-1.83], P = 0.049, respectively), while those were not significant for hospitalization for HF (hazard ratio [95% confidence interval]: 1.16 [0.97-1.38], P = 0.10, 1.19 [0.96-1.46], P = 0.11, and 1.20 [0.87-1.65], P = 0.27, respectively). The higher adjusted HRs of all the TR grades relative to no TR were significant for all-cause death in patients aged <80 years, but not in patients aged ≥80 years with significant interaction. CONCLUSIONS In a large Japanese AHF population, the grades of TR could successfully stratify the risk of all-cause death. However, the association of TR with mortality was only modest and attenuated in patients aged 80 or more. Further research is warranted to evaluate how to follow up and manage TR in this elderly population.
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Affiliation(s)
- Yuki Obayashi
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Takao Kato
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Hidenori Yaku
- Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
| | - Takeshi Morimoto
- Department of Clinical EpidemiologyHyogo College of MedicineHyogoJapan
| | - Yuta Seko
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Yasutaka Inuzuka
- Department of Cardiovascular MedicineShiga General HospitalShigaJapan
| | - Yodo Tamaki
- Division of CardiologyTenri HospitalNaraJapan
| | - Erika Yamamoto
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Yusuke Yoshikawa
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Ryoji Taniguchi
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterHyogoJapan
| | - Moritake Iguchi
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Masashi Kato
- Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
| | | | - Toshikazu Jinnai
- Department of CardiologyJapanese Red Cross Otsu HospitalShigaJapan
| | - Tomoyuki Ikeda
- Department of CardiologyHikone Municipal HospitalShigaJapan
| | - Kazuya Nagao
- Department of CardiologyOsaka Red Cross HospitalOsakaJapan
| | - Takafumi Kawai
- Department of CardiologyKishiwada City HospitalOsakaJapan
| | - Akihiro Komasa
- Department of CardiologyKansai Electric Power HospitalOsakaJapan
| | | | - Yuichi Kawase
- Department of CardiologyKurashiki Central HospitalOkayamaJapan
| | | | - Kanae Su
- Department of CardiologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | | | - Moriaki Inoko
- Cardiovascular CenterTazuke Kofukai Medical Research Institute, Kitano HospitalOsakaJapan
| | - Mamoru Toyofuku
- Department of CardiologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yutaka Furukawa
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalHyogoJapan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceShigaJapan
| | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalFukuokaJapan
| | | | - Satoshi Shizuta
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Koh Ono
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Yukihito Sato
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterHyogoJapan
| | - Koichiro Kuwahara
- Department of Cardiovascular MedicineShinshu University Graduate School of MedicineNaganoJapan
| | - Neiko Ozasa
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
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73
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Heitzinger G, Pavo N, Koschatko S, Jantsch C, Winter M, Spinka G, Dannenberg V, Kastl S, Prausmüller S, Arfsten H, Dona C, Nitsche C, Halavina K, Koschutnik M, Mascherbauer K, Gabler C, Strunk G, Hengstenberg C, Hülsmann M, Bartko PE, Goliasch G. Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum. Eur J Heart Fail 2023; 25:857-867. [PMID: 37062864 PMCID: PMC10947083 DOI: 10.1002/ejhf.2858] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023] Open
Abstract
AIM Tricuspid regurgitation secondary to heart failure (HF) is common with considerable impact on survival and hospitalization rates. Currently, insights into epidemiology, impact, and treatment of secondary tricuspid regurgitation (sTR) across the entire HF spectrum are lacking, yet are necessary for healthcare decision-making. METHODS AND RESULTS This population-based study included data from 13 469 patients with HF and sTR from the Viennese community over a 10-year period. The primary outcome was long-term mortality. Overall, HF with preserved ejection fraction was the most frequent (57%, n = 7733) HF subtype and the burden of comorbidities was high. Severe sTR was present in 1514 patients (11%), most common among patients with HF with reduced ejection fraction (20%, n = 496). Mortality of patients with sTR was higher than expected survival of sex- and age-matched community and independent of HF subtype (moderate sTR: hazard ratio [HR] 6.32, 95% confidence interval [CI] 5.88-6.80, p < 0.001; severe sTR: HR 9.04; 95% CI 8.27-9.87, p < 0.001). In comparison to HF and no/mild sTR patients, mortality increased for moderate sTR (HR 1.58, 95% CI 1.48-1.69, p < 0.001) and for severe sTR (HR 2.19, 95% CI 2.01-2.38, p < 0.001). This effect prevailed after multivariate adjustment and was similar across all HF subtypes. In subgroup analysis, severe sTR mortality risk was more pronounced in younger patients (<70 years). Moderate and severe sTR were rarely treated (3%, n = 147), despite availability of state-of-the-art facilities and universal health care. CONCLUSION Secondary tricuspid regurgitation is frequent, increasing with age and associated with excess mortality independent of HF subtype. Nevertheless, sTR is rarely treated surgically or percutaneously. With the projected increase in HF prevalence and population ageing, the data suggest a major burden for healthcare systems that needs to be adequately addressed. Low-risk transcatheter treatment options may provide a suitable alternative.
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Affiliation(s)
- Gregor Heitzinger
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Noemi Pavo
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Sophia Koschatko
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Charlotte Jantsch
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Max‐Paul Winter
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Georg Spinka
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Varius Dannenberg
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Stefan Kastl
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Suriya Prausmüller
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Henrike Arfsten
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Carolina Dona
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Christian Nitsche
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Kseniya Halavina
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | | | | | - Cornelia Gabler
- IT Systems and CommunicationsMedical University of ViennaViennaAustria
| | | | | | - Martin Hülsmann
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Philipp E. Bartko
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Georg Goliasch
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
- Department of Internal MedicineUniversity of SzegedSzegedHungary
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74
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Naeije R, Tello K, D'Alto M. Tricuspid Regurgitation: Right Ventricular Volume Versus Pressure Load. Curr Heart Fail Rep 2023; 20:208-217. [PMID: 37099262 DOI: 10.1007/s11897-023-00599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE OF THE REVIEW Tricuspid regurgitation is associated with increased mortality in proportion to right ventricular adaptation to increased volume loading and pulmonary artery pressure. We here review recent progress in the understanding of right ventricular adaptation to pre- and after-loading conditions for improved recommendations of tricuspid valve repair. RECENT FINDINGS Trans-catheter tricuspid valve repair has made the correction of tricuspid regurgitation more easily available, triggering a need of tighter indications. Several studies have shown the feasibility and relevance to the indications of tricuspid valve repair of imaging of right ventricular ejection fraction measured by magnetic resonance imaging or 3D-echocardiography, and the 2D-echocardiography of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio combined with invasively determined mean pulmonary artery pressure and pulmonary vascular resistance. Improved definitions of right ventricular failure and pulmonary hypertension may be considered in future recommendations on the treatment of tricuspid regurgitation.
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Affiliation(s)
- Robert Naeije
- Free University of Brussels, 808 Route de Lennik, B-1070, Brussels, Belgium.
| | - Khodr Tello
- Department of Internal Medicine, Institute for Lung Health, Cardiopulmonary Institute and Deutsches Zentrum Für LungenforschunUniversities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital-"L. Vanvitelli" University, Naples, Italy
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75
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Affiliation(s)
- Rebecca T Hahn
- From the Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
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76
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Sorajja P, Whisenant B, Hamid N, Naik H, Makkar R, Tadros P, Price MJ, Singh G, Fam N, Kar S, Schwartz JG, Mehta S, Bae R, Sekaran N, Warner T, Makar M, Zorn G, Spinner EM, Trusty PM, Benza R, Jorde U, McCarthy P, Thourani V, Tang GHL, Hahn RT, Adams DH. Transcatheter Repair for Patients with Tricuspid Regurgitation. N Engl J Med 2023; 388:1833-1842. [PMID: 36876753 DOI: 10.1056/nejmoa2300525] [Citation(s) in RCA: 225] [Impact Index Per Article: 225.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Severe tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid regurgitation may reduce symptoms and improve clinical outcomes in patients with this disease. METHODS We conducted a prospective randomized trial of percutaneous tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation. Patients with symptomatic severe tricuspid regurgitation were enrolled at 65 centers in the United States, Canada, and Europe and were randomly assigned in a 1:1 ratio to receive either TEER or medical therapy (control). The primary end point was a hierarchical composite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points in the KCCQ score (range, 0 to 100, with higher scores indicating better quality of life) at the 1-year follow-up. The severity of tricuspid regurgitation and safety were also assessed. RESULTS A total of 350 patients were enrolled; 175 were assigned to each group. The mean age of the patients was 78 years, and 54.9% were women. The results for the primary end point favored the TEER group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P = 0.02). The incidence of death or tricuspid-valve surgery and the rate of hospitalization for heart failure did not appear to differ between the groups. The KCCQ quality-of-life score changed by a mean (±SD) of 12.3±1.8 points in the TEER group, as compared with 0.6±1.8 points in the control group (P<0.001). At 30 days, 87.0% of the patients in the TEER group and 4.8% of those in the control group had tricuspid regurgitation of no greater than moderate severity (P<0.001). TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days. CONCLUSIONS Tricuspid TEER was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement in quality of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number, NCT03904147.).
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Affiliation(s)
- Paul Sorajja
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Brian Whisenant
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Nadira Hamid
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Hursh Naik
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Raj Makkar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Peter Tadros
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Matthew J Price
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Gagan Singh
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Neil Fam
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Saibal Kar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Jonathan G Schwartz
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Shamir Mehta
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Richard Bae
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Nishant Sekaran
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Travis Warner
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Moody Makar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - George Zorn
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Erin M Spinner
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Phillip M Trusty
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Raymond Benza
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Ulrich Jorde
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Patrick McCarthy
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Vinod Thourani
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Gilbert H L Tang
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Rebecca T Hahn
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - David H Adams
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
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77
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Orban M, Massberg S. Transcatheter Therapy for Tricuspid Regurgitation - First Act. N Engl J Med 2023; 388:1902-1903. [PMID: 37195946 DOI: 10.1056/nejme2302457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Mathias Orban
- From Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilian University of Munich (M.O., S.M.), and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance (S.M.) - both in Munich, Germany
| | - Steffen Massberg
- From Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilian University of Munich (M.O., S.M.), and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance (S.M.) - both in Munich, Germany
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78
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Curio J, Beneduce A, Giannini F. Transcatheter mitral and tricuspid interventions-the bigger picture: valvular disease as part of heart failure. Front Cardiovasc Med 2023; 10:1091309. [PMID: 37255703 PMCID: PMC10225583 DOI: 10.3389/fcvm.2023.1091309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/13/2023] [Indexed: 06/01/2023] Open
Abstract
The prevalence of mitral (MR) and tricuspid regurgitation (TR), especially in heart failure (HF) populations, is high. However, the distinct role of atrioventricular valve diseases in HF, whether they are merely indicators of disease status or rather independent contributors in a vicious disease cycle, is still not fully understood. For decades, tricuspid regurgitation (TR) was considered an innocent bystander subsequent to other heart or lung pathologies, thus, not needing dedicated treatment. Recent increasing awareness towards the role of atrioventricular valve diseases has revealed that MR and TR are, in fact, independent predictors of outcome in HF, thus, warranting attention in the HF treatment algorithm. This awareness arose, especially, with the development of minimally invasive transcatheter solutions providing new treatment options, which can also be used for patients considered as having increased surgical risk. However, outcomes of such transcatheter treatments have, in part, been sub-optimal and likely influenced by the status of the concomitant HF disease. Thus, this review aims to summarize data on the current understanding regarding the role of MR and TR in HF, how HF impacts outcomes of transcatheter MR and TR interventions, and how the understanding of this relationship might help to identify patients that benefit most from these therapies, which have proven to be lifesaving in properly selected candidates.
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Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | | | - Francesco Giannini
- Interventional Cardiology Unit, IRCCA Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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80
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Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
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81
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Cammalleri V, Antonelli G, De Luca VM, Carpenito M, Nusca A, Bono MC, Mega S, Ussia GP, Grigioni F. Functional Mitral and Tricuspid Regurgitation across the Whole Spectrum of Left Ventricular Ejection Fraction: Recognizing the Elephant in the Room of Heart Failure. J Clin Med 2023; 12:3316. [PMID: 37176756 PMCID: PMC10178924 DOI: 10.3390/jcm12093316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) occur due to cardiac remodeling in the presence of structurally normal valve apparatus. Two main mechanisms are involved, distinguishing an atrial functional form (when annulus dilatation is predominant) and a ventricular form (when ventricular remodeling and dysfunction predominate). Both affect the prognosis of patients with heart failure (HF) across the entire spectrum of left ventricle ejection fraction (LVEF), including preserved (HFpEF), mildly reduced (HFmrEF), or reduced (HFrEF). Currently, data on the management of functional valve regurgitation in the various HF phenotypes are limited. This review summarizes the epidemiology, pathophysiology, and treatment of FMR and FTR within the different patterns of HF, as defined by LVEF.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
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82
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Wang X, Ma Y, Liu Z, Fan X, Guan G, Pan S, Wang J, Zhang Y. Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency. J Cardiothorac Surg 2023; 18:170. [PMID: 37120579 PMCID: PMC10148428 DOI: 10.1186/s13019-023-02271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/04/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Tricuspid regurgitation is associated with significant morbidity and mortality, but with limited treatment options. The objective of this study is to compare the demographic characteristics, complications, and outcomes of transcatheter tricuspid valve repair (TTVr) versus surgical tricuspid valve replacement (STVR) or surgical tricuspid valve repair (STVr), using real-world data from the National Inpatient Sample (NIS) database. METHODS AND RESULTS Our study analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2018 and identified 92, 86, and 84 patients with tricuspid insufficiency who underwent STVr, STVR, and TTVr, respectively. The mean ages of patients who received STVr, STVR, and TTVr were 65.03 years, 66.3 years, and 71.09 years, respectively, with TTVr patients significantly older than those who received STVr (P < 0.05). Patients who received STVr or STVR had higher mortality rates (8.7% and 3.5%, respectively) compared to those who received TTVr (1.2%). Patients who underwent STVr or STVR were also more likely to experience perioperative complications, including third-degree atrioventricular block (8.7% STVr vs. 1.2% TTVr, P = 0.329; 38.4% STVR vs. 1.2% TTVr, P < 0.05), respiratory failure (5.4% STVr vs. 1.2% TTVr, P = 0.369; 15.1% STVR vs. 1.2% TTVr, P < 0.05), respiratory complications (6.5% STVr vs. 1.2% TTVr, P = 0.372; 19.8% STVR vs. 1.2% TTVr, P < 0.05), acute kidney injury (40.2% STVr vs. 27.4% TTVr, P = 0.367; 34.9% STVR vs. 27.4% TTVr, P = 0.617), and fluid and electrolyte disorders (44.6% STVr vs. 22.6% TTVr, P = 0.1332; 50% STVR vs. 22.6% TTVr, P < 0.05). In addition, the average cost of care and the average length of hospital stay were higher for patients who underwent STVr or STVR than for those who received TTVr (USD$37995 ± 356008.523 STVr vs. USD$198397 ± 188943.082 TTVr, P < 0.05; USD$470948 ± 614177.568 STVR vs. USD$198397 ± 188943.082 TTVr, P < 0.05; 15.4 ± 15.19 STVr vs. 9.6 ± 10.21 days TTVr, P = 0.267; 24.7 ± 28.81 STVR vs. 9.6 ± 10.21 days TTVr, P < 0.05). CONCLUSION TTVr has shown to have favorable outcomes compared to STVr or STVR, but more research and clinical trials are required to help formulate evidence-based guidelines for the role of catheter-based management in tricuspid valve disease.
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Affiliation(s)
- Xiqiang Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Yanpeng Ma
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Zhongwei Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Shuo Pan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
| | - Yong Zhang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
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83
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Fortmeier V, Lachmann M, Körber MI, Unterhuber M, Schöber AR, Stolz L, Stocker TJ, Kassar M, Gerçek M, Rudolph TK, Praz F, Windecker S, Pfister R, Baldus S, Laugwitz KL, Hausleiter J, Lurz P, Rudolph V. Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2023; 16:909-923. [PMID: 37100555 DOI: 10.1016/j.jcin.2023.01.378] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Men and women differ regarding comorbidities, pathophysiology, and the progression of valvular heart diseases. OBJECTIVES This study sought to assess sex-related differences regarding clinical characteristics and the outcome of patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI). METHODS All 702 patients in this multicenter study underwent TTVI for severe TR. The primary outcome was 2-year all-cause mortality. RESULTS Among 386 women and 316 men in this study, men were more often diagnosed with coronary artery disease (52.9% in men vs 35.5% in women; P = 5.6 × 10-6). Subsequently, the underlying etiology for TR in men was predominantly secondary ventricular (64.6% in men vs 50.0% in women; P = 1.4 × 10-4), whereas women more often presented with secondary atrial etiology (41.7% in women vs 24.4% in men, P = 2.0 × 10-6). Notably, 2-year survival after TTVI was similar in women and men (69.9% in women vs 63.7% in men; P = 0.144). Multivariate regression analysis identified dyspnea expressed as New York Heart Association functional class, tricuspid annulus plane systolic excursion (TAPSE), and mean pulmonary artery pressure (mPAP) as independent predictors for 2-year mortality. The prognostic significance of TAPSE and mPAP differed between sexes. Consequently, we looked at right ventricular-pulmonary arterial coupling expressed as TAPSE/mPAP and identified sex-specific thresholds to best predict survival; women with a TAPSE/mPAP ratio <0.612 mm/mm Hg displayed a 3.43-fold increased HR for 2-year mortality (P < 0.001), whereas men with a TAPSE/mPAP ratio <0.434 mm/mm Hg displayed a 2.05-fold increased HR for 2-year mortality (P = 0.001). CONCLUSIONS Even though men and women differ in the etiology of TR, both sexes show similar survival rates after TTVI. The TAPSE/mPAP ratio can improve prognostication after TTVI, and sex-specific thresholds should be applied to guide future patient selection.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich Germany
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas J Stocker
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich Germany; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Switzerland
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Switzerland
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich Germany
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich Germany; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
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84
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Latib A, Mangieri A, Nettersheim FS, Baldus S. Transcatheter tricuspid valve repair/replacement should be offered to all patients with severe tricuspid regurgitation: pros and cons. EUROINTERVENTION 2023; 18:1395-1397. [PMID: 37092268 PMCID: PMC10111126 DOI: 10.4244/eij-e-22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Antonio Mangieri
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Felix Sebastian Nettersheim
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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85
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Sanchis L, Sitges M, Abdul-Jawad Altisent O, Freixa X. Tailored Treatment of Patients With Intracardiac Leads and Tricuspid Regurgitation. JACC Case Rep 2023; 12:101781. [PMID: 37091060 PMCID: PMC10119508 DOI: 10.1016/j.jaccas.2023.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 04/25/2023]
Abstract
Tricuspid regurgitation (TR) is frequent in patients with leads from rhythm control devices. Percutaneous treatment of TR can be an effective therapy in these patients but needs to be tailored based on valve anatomy and the underlying mechanism of the TR as shown in the case series that we present. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Laura Sanchis
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Address for correspondence: Dr Laura Sanchis, Villarroel Street 170, Cardiology Department, PC 08036, Barcelona, Spain. @lsanchisruiz
| | - Marta Sitges
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Omar Abdul-Jawad Altisent
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Xavier Freixa
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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86
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Lawlor MK, Ng V, Ahmed S, Dershowitz L, Brener MI, Kampaktsis P, Pitts A, Vahl T, Nazif T, Leon M, George I, Hahn RT, Kodali S. Baseline Characteristics and Clinical Outcomes of a Tricuspid Regurgitation Referral Population. Am J Cardiol 2023; 196:22-30. [PMID: 37058874 DOI: 10.1016/j.amjcard.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
Adverse outcomes in tricuspid regurgitation (TR) have been associated with advanced regurgitation severity and right-sided cardiac remodeling, and late referrals for tricuspid valve surgery in TR have been associated with increase in postoperative mortality. The purpose of this study was to evaluate baseline characteristics, clinical outcomes, and procedural utilization of a TR referral population. We analyzed patients with a diagnosis of TR referred to a large TR referral center between 2016 and 2020. We evaluated baseline characteristics stratified by TR severity and analyzed time-to-event outcomes for a composite of overall mortality or heart-failure hospitalization. In total, 408 patients were referred with a diagnosis of TR: the median age of the cohort was 79 years (interquartile range 70 to 84), and 56% were female. In patients evaluated on a 5-grade scale, 10.2% had ≤moderate TR; 30.7% had severe TR; 11.4% had massive TR, and 47.7% had torrential TR. Increasing TR severity was associated with right-sided cardiac remodeling and altered right ventricular hemodynamics. In multivariable Cox regression analysis, New York Heart Association class symptoms, history of heart failure hospitalization, and right atrial pressure were associated with the composite outcome. One-third of patients referred underwent transcatheter tricuspid valve intervention (19%) or surgery (14%); patients who underwent transcatheter tricuspid valve intervention had greater preoperative risk than that of patients who underwent surgery. In conclusion, in patients referred for evaluation of TR, there were high rates of massive and torrential regurgitation and advanced right ventricle remodeling. Symptoms and right atrial pressure are associated with clinical outcomes in follow-up. There were significant differences in baseline procedural risk and eventual therapeutic modality.
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Affiliation(s)
| | - Vivian Ng
- Division of Cardiology; Structural Heart and Valve Center
| | | | | | | | | | - Amy Pitts
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Torsten Vahl
- Division of Cardiology; Structural Heart and Valve Center
| | - Tamim Nazif
- Division of Cardiology; Structural Heart and Valve Center
| | - Martin Leon
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Isaac George
- Structural Heart and Valve Center; Division of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Susheel Kodali
- Division of Cardiology; Structural Heart and Valve Center.
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87
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Caneiro-Queija B, Estévez-Loureiro R, Piñón-Esteban M, Barreiro-Pérez M, Baz-Alonso JA, Íñiguez-Romo A. Transfemoral transcatheter tricuspid valve replacement with the Cardiovalve system. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:270-272. [PMID: 36228959 DOI: 10.1016/j.rec.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Berenice Caneiro-Queija
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Miguel Piñón-Esteban
- Departamento de Cirugía Cardiaca, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Manuel Barreiro-Pérez
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - José A Baz-Alonso
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Andrés Íñiguez-Romo
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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88
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Soliman O. Tricuspid Transcatheter Edge-to-Edge Repair: The Known Knowns, and the Known Unknowns. JACC Cardiovasc Interv 2023; 16:718-721. [PMID: 36990562 DOI: 10.1016/j.jcin.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Osama Soliman
- Discipline of Cardiology, Galway University Hospital, Health Service Executive, Galway, Ireland; CORRIB Research Center for Advanced Imaging & Core Lab, and CÚRAM Centre for Medical Devices, University of Galway, Galway, Ireland.
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89
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Mohamed MS, Al Ali O, Hashem A, Abdelhay A, Khalouf A, Mahmoud A, Shehadah A, Ahmed A, Elkhapery A, Alwifati N, Rai D, Salama A, Hussein A, Khodjaev S, Feitell S. Trends and Outcomes of Transcatheter Tricuspid Valve Repair and Surgical Tricuspid Valve Repair in Patients With Tricuspid Valve Regurgitation; A Population Based Study. Curr Probl Cardiol 2023; 48:101714. [PMID: 36967066 DOI: 10.1016/j.cpcardiol.2023.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/23/2023]
Abstract
Data on clinical outcomes of transcatheter tricuspid valve repair (TTVR) compared with surgical tricuspid valve repair (STVR) in patients with tricuspid valve regurgitation (TVR) remains limited. Data from the national inpatient sample (2016-2020) and propensity-score matched (PSM) analysis was utilized to determine adjusted odds ratio (aOR) of inpatient mortality and major clinical outcomes of TTVR compated with STVR in patients with TVR. A total of 37,115 patients with TVR were included: 1830 (4.9%) and 35,285 (95.1%) underwent TTVR and STVR, respectively. After PSM, there was no statistically significant difference in baseline characteristics and medical comorbidities between both groups. Compared with STVR, TTVR was associated with lower inpatient mortality (aOR 0.43 [0.31-0.59], P < 0.01), cardiovascular complications (aOR 0.47 [0.3-0.45], P < 0.01), hemodynamic complications (aOR 0.47 [0.4-0.55], P < 0.01), infectious complications (aOR 0.44 [0.34-0.57], P < 0.01), renal complications (aOR 0.56 [0.45-0.64], P < 0.01), and need for blood transfusion. There was no statistically significant difference in odds of major bleeding events (aOR 0.92 [0.64-1.45], P 0.84). Also, TTVR was associated with less mean length of stay (7 days vs 15 days, P < 0.01) and less cost of hospitalization ($59,921 vs $89,618) compared with STVR. There was an increase in the utility of TTVR associated with a decrease in the utility of STVR from 2016 to 2020 (P < 0.01). Our study showed that compared with STVR, TTVR was associated with lower inpatient mortality and clinical events. Nevertheless, further studies are needed to investigate the difference in outcomes between both procedures.
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Affiliation(s)
| | - Omar Al Ali
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Anas Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Ali Abdelhay
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Amani Khalouf
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Amir Mahmoud
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Ahmed Elkhapery
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Nader Alwifati
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Devesh Rai
- Department of Cardiology, Rochester General Hospital, Rochester, NY
| | - Amr Salama
- Department of Cardiology, Rochester General Hospital, Rochester, NY
| | - Ahmed Hussein
- Department of Cardiology, Rochester General Hospital, Rochester, NY
| | - Soidjon Khodjaev
- Department of Cardiology, Rochester General Hospital, Rochester, NY
| | - Scott Feitell
- Department of Cardiology, Rochester General Hospital, Rochester, NY
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90
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Fortmeier V, Lachmann M, Unterhuber M, Stolz L, Kassar M, Ochs L, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz K, Praz F, Windecker S, Hausleiter J, Lurz P, Rudolph V. Epiphenomenon or Prognostically Relevant Interventional Target? A Novel Proportionality Framework for Severe Tricuspid Regurgitation. J Am Heart Assoc 2023; 12:e028737. [PMID: 36926925 PMCID: PMC10111550 DOI: 10.1161/jaha.122.028737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Background Tricuspid regurgitation (TR) frequently develops in patients with long-standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results In this multicenter study, we included 533 patients undergoing TTVI for moderate-to-severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2-year all-cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm2/mm Hg (defining proportionate TR) featured significantly lower 2-year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P=0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P<2.2×10-16) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0±4.11 versus 17.0±4.64 mm; P=0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350±0.105 cm2 versus 0.770±0.432 cm2; P<2.2×10-16). Importantly, proportionate TR remained a significant predictor for 2-year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; P=0.006). Conclusions The proposed proportionality framework promises to improve future risk stratification and clinical decision-making by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Mohammad Kassar
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Laurin Ochs
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Anne R. Schöber
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Thomas J. Stocker
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Maria I. Körber
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Amelie Hesse
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Kai Peter Friedrichs
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Shinsuke Yuasa
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Tanja K. Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Michael Joner
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Department of Cardiology, German Heart Center MunichTechnical University of MunichMunichGermany
| | - Roman Pfister
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Stephan Baldus
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Karl‐Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Fabien Praz
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Stephan Windecker
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Philipp Lurz
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
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Enriquez-Sarano M, Grapsa J. Valvular heart diseases in women: facts vs. incantations. Eur Heart J 2023; 44:833-835. [PMID: 36610069 DOI: 10.1093/eurheartj/ehac774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, London, UK
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92
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Becher PM, Seiffert M. [Interventional treatment of heart failure : Stents and valves]. Herz 2023; 48:101-108. [PMID: 36700948 DOI: 10.1007/s00059-022-05160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
The pharmacotherapy of heart failure has evolved in recent years and with the aid of new classes of drugs symptomatic and prognostic improvements can be achieved in patients with heart failure. Heart failure is particularly frequently associated with coronary artery disease or higher grade, often functional valve defects. In the context of the underlying disease, the operative risk is often increased, so that interventional treatment is preferred over surgical treatment options in interdisciplinary heart teams. Promising approaches with very different challenges are emerging for interventional myocardial revascularization and percutaneous correction of high-grade aortic valve stenosis or functional mitral or tricuspid valve regurgitation. It has consistently been shown that an elaborate diagnostic work-up and differentiated patient selection are decisive to achieve a prognostic or symptomatic benefit in these patients using interventional treatment. While awaiting further study data on this topic, the integration of a multidisciplinary heart team is essential to ensure a complementary and balanced therapeutic approach for patient-centered care in this complex patient population.
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Affiliation(s)
- Peter Moritz Becher
- Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, 20246, Hamburg, Deutschland. .,Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Hamburg, Deutschland.
| | - Moritz Seiffert
- Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, 20246, Hamburg, Deutschland.,Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Hamburg, Deutschland
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93
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Sun ZY, Li Q, Li J, Zhang MW, Zhu L, Geng J. Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100274. [PMID: 38511096 PMCID: PMC10945901 DOI: 10.1016/j.ahjo.2023.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/22/2024]
Abstract
Right atrial (RA) structural and functional evaluations have recently emerged as powerful biomarkers for adverse events in various cardiovascular conditions. Quantitative analysis of the right atrium, usually performed with volume changes or speckle-tracking echocardiography (STE), has markedly changed our understanding of RA function and remodeling. Knowledge of reference echocardiographic values and measurement methods of RA volumes and myocardial function is a prerequisite to introduce RA quantitation in the clinical routine. This review describes the methodology, benefits and pitfalls of measuring RA size and function by echocardiography based on the current understanding of right atrial anatomy and physiological function and provides the current knowledge of right atrial function in related cardiac diseases.
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Affiliation(s)
- Zhen-Yun Sun
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Qiao Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jun Li
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Ming-Wei Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Ling Zhu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jing Geng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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94
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Hinojar R, Zamorano JL, González Gómez A, García-Martin A, Monteagudo JM, García Lunar I, Sanchez Recalde A, Fernández-Golfín C. Prognostic Impact of Right Ventricular Strain in Isolated Severe Tricuspid Regurgitation. J Am Soc Echocardiogr 2023:S0894-7317(23)00094-9. [PMID: 36828258 DOI: 10.1016/j.echo.2023.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Right ventricular (RV) systolic function is an established marker of outcomes in patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction using conventional two-dimensional echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for the evaluation of RV function, with the capability to detect subclinical RV dysfunction. The aim of this study was to evaluate the prognostic value of RV strain parameters in early stages of severe TR. METHODS Consecutive patients with at least severe TR (severe, massive, or torrential) and the absence of a formal indication for tricuspid valve intervention in secondary TR evaluated in the Heart Valve Clinic were prospectively included. RV systolic function was measured using conventional echocardiographic indices (RV fractional area change, tricuspid annular plane systolic excursion, and Doppler tissue imaging S wave [S']) and speckle-tracking echocardiography-derived automatic peak global longitudinal strain and free wall longitudinal strain (FWLS) using an automated two-dimensional strain analytic software. A combined end point of hospital admission due to heart failure or all-cause mortality was defined. RESULTS A total of 266 patients were enrolled in the study, and 151 were ultimately included. Strain parameters detected a higher percentage of abnormal RV values compared with conventional indices. During a median follow-up period of 26 months (interquartile range, 13-42 months), 35% of the patients reached the combined end point. Cumulative event-free survival was significantly worse in patients with impaired RV global longitudinal strain and RV FWLS. Conventional indices of RV systolic function were not associated with outcomes (P > .05 for all). On multivariate analysis, RV FWLS was independently associated with mortality and heart failure (adjusted hazard ratio for abnormal RV FWLS, 5.90; 95% CI, 3.17-10.99; P < .001). CONCLUSION In early stages of severe TR, RV FWLS is more frequently impaired compared with conventional indices of RV function. Among all parameters, RV FWLS is the strongest predictor of mortality and heart failure, independent of additional prognostic markers.
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Affiliation(s)
- Rocio Hinojar
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ariana González Gómez
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Ana García-Martin
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Juan Manuel Monteagudo
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Inés García Lunar
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Angel Sanchez Recalde
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Covadonga Fernández-Golfín
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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95
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Transcatheter Tricuspid Valve Replacement: Illustrative Case Reports and Review of State-of-Art. J Clin Med 2023; 12:jcm12041371. [PMID: 36835907 PMCID: PMC9967402 DOI: 10.3390/jcm12041371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Tricuspid regurgitation (TR) is one of the most common heart valve diseases, associated a with poor prognosis since significant TR is associated with an increased mortality risk compared to no TR or mild regurgitation. Surgery is the standard treatment for TR, although it is associated with high morbidity, mortality, and prolonged hospitalization, particularly in tricuspid reoperation after left-sided surgery. Thus, several innovative percutaneous transcatheter approaches for repair and replacement of the tricuspid valve have gathered significant momentum and have undergone extensive clinical development in recent years, with favorable clinical outcomes in terms of mortality and rehospitalization during the first year of follow-up. We present three clinical cases of transcatheter tricuspid valve replacement in an orthotopic position with two different innovative systems along with a review of the state-of-the-art of this emergent topic.
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96
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Key Echocardiographic Considerations for Tricuspid Valve Transcatheter Edge-to-Edge Repair. J Am Soc Echocardiogr 2023; 36:366-380.e1. [PMID: 36754098 DOI: 10.1016/j.echo.2023.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Chronic tricuspid regurgitation (TR) results in progressive right ventricular (RV) volume overload, followed by right-sided chamber dilatation, RV systolic dysfunction, and eventual low-output cardiac failure. Severe TR is associated with considerable morbidity and mortality, and yet until recently, patients in the late stage of their disease course had limited treatment options. Cognizant of the high mortality rates associated with surgical intervention, tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) has emerged as a promising solution for patients with severe TR. As has been learned from the transcatheter mitral valve TEER experience, detailed morphological and mechanistic assessment of the TV with transthoracic and transesophageal imaging is essential to optimal patient selection and procedural success. The current review will provide a comprehensive overview of TV anatomy, the updated mechanistic classification of TR, and key echocardiographic considerations in the evaluation, management, and follow-up of patients undergoing TV TEER.
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97
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Trenkwalder T, Lachmann M, Stolz L, Fortmeier V, Covarrubias HAA, Rippen E, Schürmann F, Presch A, von Scheidt M, Ruff C, Hesse A, Gerçek M, Mayr NP, Ott I, Schuster T, Harmsen G, Yuasa S, Kufner S, Hoppmann P, Kupatt C, Schunkert H, Kastrati A, Laugwitz KL, Rudolph V, Joner M, Hausleiter J, Xhepa E. Machine learning identifies pathophysiologically and prognostically informative phenotypes among patients with mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J Cardiovasc Imaging 2023; 24:574-587. [PMID: 36735333 DOI: 10.1093/ehjci/jead013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
AIMS Patients with mitral regurgitation (MR) present with considerable heterogeneity in cardiac damage depending on underlying aetiology, disease progression, and comorbidities. This study aims to capture their cardiopulmonary complexity by employing a machine-learning (ML)-based phenotyping approach. METHODS AND RESULTS Data were obtained from 1426 patients undergoing mitral valve transcatheter edge-to-edge repair (MV TEER) for MR. The ML model was developed using 609 patients (derivation cohort) and validated on 817 patients from two external institutions. Phenotyping was based on echocardiographic data, and ML-derived phenotypes were correlated with 5-year outcomes. Unsupervised agglomerative clustering revealed four phenotypes among the derivation cohort: Cluster 1 showed preserved left ventricular ejection fraction (LVEF; 56.5 ± 7.79%) and regular left ventricular end-systolic diameter (LVESD; 35.2 ± 7.52 mm); 5-year survival in Cluster 1, hereinafter serving as a reference, was 60.9%. Cluster 2 presented with preserved LVEF (55.7 ± 7.82%) but showed the largest mitral valve effective regurgitant orifice area (0.623 ± 0.360 cm2) and highest systolic pulmonary artery pressures (68.4 ± 16.2 mmHg); 5-year survival ranged at 43.7% (P-value: 0.032). Cluster 3 was characterized by impaired LVEF (31.0 ± 10.4%) and enlarged LVESD (53.2 ± 10.9 mm); 5-year survival was reduced to 38.3% (P-value: <0.001). The poorest 5-year survival (23.8%; P-value: <0.001) was observed in Cluster 4 with biatrial dilatation (left atrial volume: 312 ± 113 mL; right atrial area: 46.0 ± 8.83 cm2) although LVEF was only slightly reduced (51.5 ± 11.0%). Importantly, the prognostic significance of ML-derived phenotypes was externally confirmed. CONCLUSION ML-enabled phenotyping captures the complexity of extra-mitral valve cardiac damage, which does not necessarily occur in a sequential fashion. This novel phenotyping approach can refine risk stratification in patients undergoing MV TEER in the future.
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Affiliation(s)
- Teresa Trenkwalder
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Mark Lachmann
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | | | - Elena Rippen
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Friederike Schürmann
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Antonia Presch
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Celine Ruff
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Amelie Hesse
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | - N Patrick Mayr
- Institute of Anesthesiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Ilka Ott
- Department of Cardiology, Helios Klinikum Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada
| | - Gerhard Harmsen
- Department of Physics, University of Johannesburg, Auckland Park, 5 Kingsway Avenue, Rossmore, 2092 Johannesburg, South Africa
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, 35-Shinanomachi, Shinjuku-ku, 160-8582 Tokyo, Japan
| | - Sebastian Kufner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Petra Hoppmann
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Christian Kupatt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | - Michael Joner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
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98
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Wu J, Huang X, Huang K, Tian Y, Gao Q, Lin B, Tang Y, Chen X, Su M. Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four-dimensional echocardiography study. Echocardiography 2023; 40:113-127. [PMID: 36647764 PMCID: PMC10107205 DOI: 10.1111/echo.15528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/11/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tricuspid annulus (TA) geometry and function reference values are limited, especially for Asian populations. We aimed to explore TA using four-dimensional echocardiography (4DE) in a healthy Asian population. METHODS A total of 355 healthy Asian volunteers (median age 34 years; 52% males) were prospectively enrolled. TA geometry and function were analyzed using 4DE throughout the cardiac cycle. RESULTS The TA area, perimeter, and dimensions were smallest at end systole (ES) and largest at late diastole (LD). Normal TA parameters at end diastole (ED) in different sex and age groups were obtained. TA areas, perimeters, and dimensions in males were significantly larger than those in females at ED; BSA-indexed perimeters and BSA-indexed dimensions in males were significantly smaller than those in females at ED. TA parameters correlated well with tricuspid valve (TV) tenting, right ventricle (RV), and right atrium (RA) parameters. CONCLUSIONS Reference values of TA parameters were obtained by 4DE in an Asian population. Quantitative data on TA geometry and function are essential for TA pathology and therapeutics.
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Affiliation(s)
- Jian Wu
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Xinyi Huang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Kunhui Huang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Yuan Tian
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Qiumei Gao
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Biqin Lin
- Department of Ultrasonography, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, China
| | - Yiruo Tang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Xu Chen
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Maolong Su
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
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99
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Sisinni A, Taramasso M, Praz F, Metra M, Agricola E, Margonato A, Fam N, Estevez-Loureiro R, Latib A, Messika-Zeitoun D, Conradi L, von Bardeleben RS, Sorajja P, Hahn RT, Caravita S, Maisano F, Adamo M, Godino C. Concomitant Transcatheter Edge-to-Edge Treatment of Secondary Tricuspid and Mitral Regurgitation: An Expert Opinion. JACC Cardiovasc Interv 2023; 16:127-139. [PMID: 36697147 DOI: 10.1016/j.jcin.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
Secondary (functional) tricuspid regurgitation (sTR) is common in patients with mitral regurgitation (MR). Because combined valvular heart disease affects long-term survival, in comparison with isolated MR or tricuspid regurgitation, it is essential to offer patients adequate treatment. Despite considerable experience, no conclusive data are yet available on the prognostic impact of concomitant tricuspid valve surgery at the time of mitral valve surgery. Emerging transcatheter treatments offer the opportunity to treat both conditions (MR and sTR) simultaneously or in a stepwise fashion. This review provides a clinical overview on available data regarding the rationale for treatment of sTR in patients with relevant MR undergoing mitral transcatheter edge-to-edge repair, focusing on clinical and anatomical selection criteria.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy. https://twitter.com/antosis_93
| | | | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marco Metra
- Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic- Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Sergio Caravita
- Dyspnea and Pulmonary Hypertension Center, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
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100
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Lu F, Xiong T, Chen M. Evaluation of systemic impact of tricuspid regurgitation: an appeal for the notion of tricuspid regurgitation syndrome. Chin Med J (Engl) 2023; 136:138-140. [PMID: 36752789 PMCID: PMC10106265 DOI: 10.1097/cm9.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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