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Arfsten H, König A, Geller W, Bodner L, Dannenberg V, Prausmüller S, Bartko PE, Binder T, Hengstenberg C, Goliasch G, Schneider-Reigbert M. Annular remodelling predicts outcome in isolated severe tricuspid regurgitation: a registry-based echocardiographic analysis. Eur Heart J Cardiovasc Imaging 2024; 25:795-803. [PMID: 38198413 DOI: 10.1093/ehjci/jeae012] [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: 09/21/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
AIMS Depending on volume status, secondary tricuspid regurgitation (sTR) has a strong dynamic component. In contrast, associated structural dilatation of the tricuspid annulus and the right heart chambers may be less volume dependent. This study aimed to assess the prognostic value of right heart remodelling in isolated severe sTR (isoTR). METHODS AND RESULTS A total of 36 000 patients from the longitudinal echocardiographic database of our tertiary centre were screened for severe isoTR [vena contracta (VC) ≥ 7 mm] in the absence of atrial fibrillation (AF), other valve disease, and/or reduced systolic left ventricular function. Echocardiographic examinations were re-read, focusing on right ventricular (RV) parameters and on quantitative and qualitative parameters of isoTR. All-cause mortality was defined as the primary endpoint. Two hundred and sixteen patients fulfilled the inclusion criteria. Severe TR was predominant; only few were classified in the new grades massive [n = 23 (10%)] and torrential TR [n = 4 (2%)]. During a median follow-up of 35 months (20-53), all-cause mortality was 31% (n = 67). Multivariate Cox regression analysis revealed no association of VC, effective regurgitant orifice area, or regurgitant volume with all-cause mortality. However, indexed RV end-diastolic diameter (P < 0.001), indexed right atrial dimensions (P = 0.019), and particularly tricuspid valve (TV) annulus diameter diastole index (P = 0.002) and TV annulus diameter systole index (P = 0.001) were significantly associated with outcome. CONCLUSION Severe isolated TR in the absence of AF is a rare finding with a grim prognosis. Tricuspid annular diameter dimensions rather than quantitative measures of TR proved to be of significant prognostic value indicating a continuous remodelling leading to a 'point of no return' with a dismal outcome.
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Affiliation(s)
- Henrike Arfsten
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Andreas König
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Welf Geller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Lorenz Bodner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Suriya Prausmüller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Philipp E Bartko
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Thomas Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | - Matthias Schneider-Reigbert
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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Ho EC, Latib A. Imaging for transcatheter native tricuspid valve intervention: patient selection, procedural planning and interventional guidance. Minerva Cardiol Angiol 2021; 69:707-719. [PMID: 34472772 DOI: 10.23736/s2724-5683.21.05697-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging in the pre-procedural and periprocedural period is essential for procedural and clinical success. Echocardiographic-based techniques are particularly important in these procedures, especially for interventional guidance. This review summarizes the current devices in use and how imaging is used for patient selection, procedural planning, and interventional guidance. The most commonly used method of transcatheter tricuspid intervention is edge-to-edge repair using the MitraClip or TriClip devices (Abbott, Santa Clara, CA, USA). Randomized controlled data is pending but observational studies have demonstrated success, especially in the setting of smaller coaptation gaps and adequate transesophageal imaging windows. Direct annuloplasty with the Cardioband (Edwards Lifesciences, Irvine, CA, USA) has also been used in many centers and has demonstrated success when the anatomy and mechanism of tricuspid regurgitation are appropriate for annuloplasty based on imaging evaluation. Lastly, transcatheter valve replacement is becoming more common using several investigational devices and relies heavily on imaging methods to achieve procedural success.
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Affiliation(s)
- Edwin C Ho
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA -
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA
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Deichl AS, Lacour P, Belyavskiy E, Pieske B, Pieske-Kraigher E, Blaschke F, Schneider M. Case Report: Assessing the Position of Pacemaker Leads via Transthoracic Echocardiography: Additional Value of the Subcostal En Face View. Front Cardiovasc Med 2021; 8:697052. [PMID: 34150875 PMCID: PMC8213207 DOI: 10.3389/fcvm.2021.697052] [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: 04/18/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
There is an association between presence of cardiac implantable electronic devices (CIED) and development of tricuspid regurgitation (TR). Mechanisms proposed to explain CIED-induced TR can be classified as implantation-related, lead-related, and pacing-related. Lead-related TR results from the direct interaction of the lead with the tricuspid valve (TV). The localization of the lead at the TV level directly influences the probability of subsequent development of significant TR. A transthoracic subcostal en face view of the TV can be acquired in most patients through a 90° rotation from the subcostal 4-chamber view with clear anatomic delineation of the TV and the commissures including lead position. This case-series presents three examples where the transthoracic en face view could add incremental information on the position of the pacemaker leads and on the mechanism of TR. Conclusion: When performing transthoracic echocardiography in patients with trans-tricuspid CIED lead(s), an en face view of the TV with exact reporting of the position of the lead(s) should be included.
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Affiliation(s)
- Andrea Simone Deichl
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Philipp Lacour
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
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Schneider M, König A, Geller W, Dannenberg V, Winter MP, Binder T, Hengstenberg C, Mascherbauer J, Goliasch G. Severe tricuspid regurgitation: prognostic role of right heart remodelling and pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2021; 23:246-254. [PMID: 33615333 DOI: 10.1093/ehjci/jeab027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Left heart diseases (LHDs) are the main driving forces for the development of functional tricuspid regurgitation (TR). Therefore, in most cases, the true prognostic value of TR remains concealed by concomitant LHD. This study aimed to analyse right heart remodelling in patients with TR without other valve disease and with normal systolic left ventricular function (sysLVF), and to stratify its prognostic value in the presence (dPH, maximal TR velocity signal (TRVmax) ≥ 3.5 m/s in echocardiography) or absence (nsPH, TRVmax < 3.5m/s) of concomitant pulmonary hypertension (PH). METHODS AND RESULTS We performed an observational analysis of all patients diagnosed with TR in the absence of other valve disease and reduced sysLVF at our institution between 1 January 2003 and 31 December 2013. Five-year mortality was chosen as endpoint. The final cohort entailed 29 979 consecutive patients (median age 60 years, interquartile range 46-70), 49.9% were male, mean follow-up was 95±49 months. Severe TR was present in 790 patients (2.6%). In dPH and in nsPH, severe TR was associated with an excess 5-year mortality that was even more pronounced in the dPH group (58.2% vs. 43.6%, P = 0.001). In nsPH, right ventricular dysfunction predicted mortality. In dPH, mortality was independent of presence or absence of right heart dilatation or dysfunction. CONCLUSION Severe TR without concomitant left heart valve disease or LV systolic dysfunction was a rare disease in this large-scale all-comer population and is associated with an unfavourable prognosis. The differentiation of patients with nsPH and dPH is essential as they present with different patterns of right heart remodelling and with different long-time outcomes.
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Affiliation(s)
- Matthias Schneider
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Andreas König
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Welf Geller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Max-Paul Winter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Thomas Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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