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Tribouilloy C, Vanhaecke P, Dreyfus J, Le Tourneau T, Lavie-Badie Y, Selton-Suty C, Coisne A, Donal E, Enriquez-Sarano M, Bohbot Y. Natural History of Isolated Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033933. [PMID: 38700043 PMCID: PMC11179871 DOI: 10.1161/jaha.124.033933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France
- Unite de recherche Universite Picardie Jules Verne 7517, Jules Verne University of Picardie Amiens France
| | - Pierre Vanhaecke
- Department of Cardiology Amiens University Hospital Amiens France
| | - Julien Dreyfus
- Cardiology Department Centre Cardiologique du Nord Saint-Denis France
| | - Thierry Le Tourneau
- l'Institut du Thorax, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Université Nantes Nantes France
| | - Yoan Lavie-Badie
- Department of Cardiology Rangueil University Hospital Toulouse France
| | - Christine Selton-Suty
- Cardiology Department Centre d'Investigation Clinique - Epidémiologie Clinique Centre hospitalier universitaire Nancy-Brabois Nancy France
| | - Augustin Coisne
- University Lille, Inserm, Centre hospitalier universitaire Lille, Institut Pasteur de Lille, U1011-European Genomic Institute for Diabetes Lille France
- Cardiovascular Research Foundation New York NY
| | - Erwan Donal
- University of Rennes, Centre hospitalier universitaire Rennes, institut national de la santé et de la recherche médicale, Laboratoire du traitement et du signal de l'image-UMR 1099 Rennes France
| | | | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France
- Unite de recherche Universite Picardie Jules Verne 7517, Jules Verne University of Picardie Amiens France
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2
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Wang Y, Zhai M, Mao Y, Yang T, Zhu G, Liu Y, Yang J. Transcatheter tricuspid valve replacement for functional tricuspid regurgitation after left-sided valve surgery: A single-center experience. Catheter Cardiovasc Interv 2024; 103:626-636. [PMID: 38353507 DOI: 10.1002/ccd.30972] [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: 11/26/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Functional tricuspid regurgitation (FTR) following left-sided valve surgery (LSVS) is of clinical significance due to its high recurrence and mortality rates. Transcatheter therapy presents a potential solution to address this issue. AIMS The study aimed to assess the safety and efficacy of transcatheter tricuspid valve replacement using the Lux-Valve system in a single center for patients with FTR after LSVS. METHODS From June 2020 to April 2023, 20 patients with symptomatic severe FTR after LSVS were referred to our center. A multidisciplinary cardiac team evaluated these patients for suitability for transcatheter tricuspid valve replacement with Lux-Valve systems. Primary efficacy and safety endpoints were immediate postoperative tricuspid regurgitation severity ≤ moderate and major adverse events during follow-up. RESULTS Twenty patients (average age 65.7 ± 7.4 years; 65.0% women) successfully underwent Lux-Valve system implantation after LSVS. All patients achieved ≤ moderate tricuspid regurgitation immediately after the procedure. Only one patient (5.0%) experienced a procedure-related major adverse event, leading to in-hospital mortality due to pulmonary infection. At the 6-month follow-up, 17 patients (89.5%) improved to New York Heart Association functional class I to II (p < 0.001). The overall Kansas City Cardiomyopathy Questionnaire score significantly improved (35.9 ± 6.7 points to 58.9 ± 5.8 points, p < 0.001). CONCLUSION The Lux-Valve system was found to be safe and effective for treating FTR after LSVS. It resulted in positive early outcomes, including a significant reduction in FTR, improved functional status, and enhanced quality of life, especially in high-risk patients.
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Affiliation(s)
- Yiwei Wang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Mengen Zhai
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Tingting Yang
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
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3
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Suc G, Cachier A, Hentic O, Bazire B, Sannier A, Delhomme C, Nataf P, Laschet J, Deschamps L, Garbarz E, Ou P, Caligiuri G, Iung B, Ruszniewski P, de Mestier L, Arangalage D. Management and outcomes of carcinoid heart disease with liver metastases of midgut neuroendocrine tumours. Heart 2023; 110:132-139. [PMID: 37463732 DOI: 10.1136/heartjnl-2023-322945] [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: 05/09/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Despite recent advances in surgical and interventional techniques, knowledge on the management of carcinoid heart disease (CHD) remains limited. In a cohort of patients with liver metastases of midgut neuroendocrine tumours (NETs), we aimed to describe the perioperative management and short-term outcomes of CHD. METHODS From January 2003 to June 2022, consecutive patients with liver metastases of midgut NETs and severe CHD (severe valve disease with symptoms and/or right ventricular enlargement) were included at Beaujon and Bichat hospitals. All patients underwent clinical evaluation and echocardiography. RESULTS Out of 43 (16%) consecutive patients with severe CHD and liver metastases of midgut NETs, 79% presented with right-sided heart failure. Tricuspid valve replacement was performed in 26 (53%) patients including 19 (73%) cases of combined pulmonary valve replacement. The 30-day postoperative mortality rate was high (19%), and preoperative heart failure was associated with worse survival (p=0.02). Epicardial pacemakers were systematically implanted in operated patients and 25% were permanently paced. A postoperative positive right ventricular remodelling was observed (p<0.001). A greater myofibroblastic infiltration was observed in pulmonary versus tricuspid valves (p<0.001), suggesting that they may have been explanted at an earlier stage of the disease than the tricuspid valve, with therefore potential for evolution. CONCLUSIONS We observed a high postoperative mortality rate and baseline right-sided heart failure was associated with worse outcome. In surviving patients, a positive right ventricular remodelling was observed. Prospective, multicentre studies are warranted to better define the management strategy and to identify biomarkers associated with outcome in CHD.
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Affiliation(s)
- Gaspard Suc
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Agnès Cachier
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
| | - Olivia Hentic
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Baptiste Bazire
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Aurélie Sannier
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Pathology, Bichat Hospital, AP-HP, Paris, France
| | - Clémence Delhomme
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Patrick Nataf
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Jamila Laschet
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
| | | | - Eric Garbarz
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
| | - Phalla Ou
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Radiology, Bichat Hospital, AP-HP, Paris, France
| | - Giuseppina Caligiuri
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Bernard Iung
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, Paris, France
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Louis de Mestier
- Université Paris Cité, Paris, France
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Dimitri Arangalage
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
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4
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Nickenig G, Sugiura A. Sex and TTVI: Equality in Efficacy. JACC Cardiovasc Interv 2023; 16:924-926. [PMID: 37029019 DOI: 10.1016/j.jcin.2023.02.035] [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: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
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5
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Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli PS, Guazzi M, Lorusso R, Carugo S, Faggiano P. The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management. J Clin Med 2023; 12:2178. [PMID: 36983180 PMCID: PMC10054046 DOI: 10.3390/jcm12062178] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Valvular heart disease is a leading cause of cardiovascular morbidity and mortality and a major contributor of symptoms and functional disability. Knowledge of valvular heart disease epidemiology and a deep comprehension of the geographical and temporal trends are crucial for clinical advances and the formulation of effective health policy for primary and secondary prevention. This review mainly focuses on the epidemiology of primary (organic, related to the valve itself) valvular disease and its management, especially emphasizing the importance of heart valve centers in ensuring the best care of patients through a multidisciplinary team.
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Affiliation(s)
- Gloria Santangelo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Pasquale Simone Simeoli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), The Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, The Netherlands
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pompilio Faggiano
- Cardiothoracic Department Unit, Fondazione Poliambulanza, Via Leonida Bissolati 57, 25100 Brescia, Italy
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6
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Scotti A, Coisne A, Taramasso M, Granada JF, Ludwig S, Rodés-Cabau J, Lurz P, Hausleiter J, Fam N, Kodali SK, Rosiene J, Feinberg A, Pozzoli A, Alessandrini H, Biasco L, Brochet E, Denti P, Estévez-Loureiro R, Frerker C, Ho EC, Monivas V, Nickenig G, Praz F, Puri R, Sievert H, Tang GHL, Andreas M, Von Bardeleben RS, Rommel KP, Muntané-Carol G, Gavazzoni M, Braun D, Koell B, Kalbacher D, Connelly KA, Juliard JM, Harr C, Pedrazzini G, Russo G, Philippon F, Schofer J, Thiele H, Unterhuber M, Himbert D, Alcázar MU, Wild MG, Windecker S, Jorde U, Maisano F, Leon MB, Hahn RT, Latib A. Sex-related characteristics and short-term outcomes of patients undergoing transcatheter tricuspid valve intervention for tricuspid regurgitation. Eur Heart J 2023; 44:822-832. [PMID: 36445158 DOI: 10.1093/eurheartj/ehac735] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/04/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS The impact of sexuality in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI vs. medical therapy alone. METHODS AND RESULTS The Transcatheter Tricuspid Valve Therapies (TriValve) registry collected data on patients with significant TR from 24 centres who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥severe isolated TR diagnosed in 2015-18. The primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality 80.9% vs. 77.9%, P = 0.56, nor in HF hospitalization (P = 0.36), NYHA Functional Classes III and IV (P = 0.17), and TR severity >2+ at last follow-up (P = 0.42). Multivariable Cox-regression weighted by IPTW showed improved 1-year survival after TTVI compared with medical therapy alone in both women (adjusted hazard ratio 0.45, 95% confidence interval 0.23-0.83, P = 0.01) and men (adjusted hazard ratio 0.42, 95% confidence interval 0.18-0.89, P = 0.03). CONCLUSION After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA.,University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, F-59000 Lille, France
| | | | | | - Sebastian Ludwig
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA.,Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St Michael's Hospital, Toronto, Ontario, Canada
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joel Rosiene
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ari Feinberg
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Hannes Alessandrini
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4. Via Battitore 7, 10071 Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Eric Brochet
- Division of Cardiology, Bichat Hospital, Paris, France
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Christian Frerker
- University Heart Center, Schleswig-Holstein University, Lübeck, Germany
| | - Edwin C Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Georg Nickenig
- Division of Cardiology, Bonn University Hospital, Bonn, Germany
| | - Fabien Praz
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Horst Sievert
- Division of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Karl-Philipp Rommel
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Claudia Harr
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.,Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giulio Russo
- Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Joachim Schofer
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Mirjam G Wild
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ulrich Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, NY, USA.,Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Rebecca T Hahn
- Cardiovascular Research Foundation, New York, NY, USA.,Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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7
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Lee JY, Li WY, Wu CI, Huang MS, Lee WH, Liu YW, Tsai WC. Significance of strictly defined idiopathic tricuspid regurgitation. J Chin Med Assoc 2023; 86:176-182. [PMID: 36306389 DOI: 10.1097/jcma.0000000000000836] [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] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Moderate to severe tricuspid regurgitation (TR) is known to cause right ventricular (RV) failure and death. Although TR is traditionally classified as primary or secondary, recently, a new class of TR called idiopathic TR has been proposed, with varying definitions among different studies. METHODS The data were retrospectively collected for the period of January to June 2018 for 8711 patients from the patient cohort of the National Cheng Kung University Hospital echocardiography laboratory. A total of 670 patients (7.7%) with moderate-to-severe TR were included. Idiopathic TR was diagnosed strictly using a new systematic approach. RESULTS The distribution of significant TR included 74 (11.0%) primary TR cases, 48 (7.2%) with pacemaker-related TR, 267 (39.9%) with left heart disease, 24 (3.6%) with congenital heart disease, 6 (0.9%) with RV myopathy, 105 (15.7%) with pulmonary hypertension, and 146 (21.8%) with idiopathic TR. The mean age in primary and idiopathic TR groups was older ( p = 0.004), with lower estimated pulmonary pressure ( p < 0.001), higher RV fraction area change (FAC, p < 0.001), and tricuspid annulus systolic velocity (S', p = 0.004) compared with functional TR group. Multivariate analysis showed that idiopathic TR ( p = 0.002) and primary TR ( p = 0.008) had better RV FAC than functional TR. CONCLUSION Idiopathic TR was associated with better RV function than the other secondary TRs. Thus, idiopathic TR should be strictly defined and regarded as a distinct type of TR.
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Affiliation(s)
- Jen-Yuan Lee
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, ROC
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wen-Yao Li
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Chun-I Wu
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan, ROC
| | - Mu-Shiang Huang
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wen-Huang Lee
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Yen-Wen Liu
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wei-Chuan Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan, ROC
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8
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Bohbot Y, Tordjman L, Dreyfus J, Le Tourneau T, Lavie-Badie Y, Selton-Suty C, Elegamandji B, L’official G, Fraix A, Aghezzaf S, Turgeon PY, Messika Zeitoun D, Enriquez-Sarano M, Coisne A, Donal E, Tribouilloy C. Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk. Front Cardiovasc Med 2023; 10:1090572. [PMID: 37180795 PMCID: PMC10172668 DOI: 10.3389/fcvm.2023.1090572] [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: 11/05/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes. Materials and methods In this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm2) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality. Results The relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA <60 mm2 vs. ≥60 mm2 (68 ± 3% vs. 64 ± 5%, p = 0.89). A TCG ≥10 mm was associated with lower four-year survival than a TCG <10 mm (53 ± 7% vs. 69 ± 3%, p < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95% CI] = 1.47[1.13-2.21], p = 0.019) and cardiovascular mortality (adjusted HR[95% CI] = 2.12[1.33-3.25], p = 0.001), whereas an EROA ≥60 mm2 was not associated with all-cause or cardiovascular mortality (adjusted HR[95% CI]: 1.16[0.81-1.64], p = 0.416, and adjusted HR[95% CI]: 1.07[0.68-1.68], p = 0.784, respectively). Conclusion The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated significant functional TR.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Léa Tordjman
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | | | | | - Antoine Fraix
- Cardiology Department CIC-EC, CHU Nancy-Brabois, Nancy, France
| | - Samy Aghezzaf
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
| | | | | | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Augustin Coisne
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
- Cardiovascular Research Foundation, New York, NY, United States
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI—UMR 1099, University of Rennes, Rennes, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Correspondence: Christophe Tribouilloy
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9
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Ghio S, Bossone E, Mercurio V, Rudski L, Vannan M. Echocardiographic assessment and clinical implication of functional tricuspid regurgitation in heart failure with reduced or preserved ejection fraction (ECLIPSE-HF). Int J Cardiovasc Imaging 2022; 38:2581-2591. [DOI: 10.1007/s10554-022-02599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/10/2022] [Indexed: 11/05/2022]
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10
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Dannenberg V, Koschutnik M, Donà C, Nitsche C, Mascherbauer K, Heitzinger G, Halavina K, Kammerlander AA, Spinka G, Winter MP, Andreas M, Mach M, Schneider M, Bartunek A, Bartko PE, Hengstenberg C, Mascherbauer J, Goliasch G. Invasive Hemodynamic Assessment and Procedural Success of Transcatheter Tricuspid Valve Repair—Important Factors for Right Ventricular Remodeling and Outcome. Front Cardiovasc Med 2022; 9:891468. [PMID: 35722132 PMCID: PMC9200997 DOI: 10.3389/fcvm.2022.891468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Severe tricuspid regurgitation (TR) is a common condition promoting right heart failure and is associated with a poor long-term prognosis. Transcatheter tricuspid valve repair (TTVR) emerged as a low-risk alternative to surgical repair techniques. However, patient selection remains controversial, particularly regarding the benefits of TTVR in patients with pulmonary hypertension (PH). Aim We aimed to investigate the impact of preprocedural invasive hemodynamic assessment and procedural success on right ventricular (RV) remodeling and outcome. Methods All patients undergoing TTVR with a TR reduction of ≥1 grade without precapillary or combined PH [mean pulmonary artery pressure (mPAP) ≥25 mmHg, mean pulmonary artery Wedge pressure ≤ 15 mmHg, pulmonary vascular resistance ≥3 Wood units] were assigned to the responder group. All patients with a TR reduction of ≥1 grade and precapillary or combined PH were classified as non-responders. Patients with a TR reduction ≥2 grade were directly classified as responders, and patients without TR reduction were directly assigned as non-responders. Results A total of 107 patients were enrolled, 75 were classified as responders and 32 as non-responders. We observed evidence of significant RV reverse remodeling in responders with a decrease in RV diameters (−2.9 mm, p = 0.001) at a mean follow-up of 229 days (±219 SD) after TTVR. RV function improved in responders [fractional area change (FAC) + 5.7%, p < 0.001, RV free wall strain +3.9%, p = 0.006], but interestingly further deteriorated in non-responders (FAC −4.5%, p = 0.003, RV free wall strain −3.9%, p = 0.007). Non-responders had more persistent symptoms than responders (NYHA ≥3, 72% vs. 11% at follow-up). Subsequently, non-response was associated with a poor long-term prognosis in terms of death, heart failure (HF) hospitalization, and re-intervention after 2 years (freedom of death, HF hospitalization, and reintervention at 2 years: 16% vs. 78%, log-rank: p < 0.001). Conclusion Hemodynamic assessment before TTVR and procedural success are significant factors for patient prognosis. The hemodynamic profiling prior to intervention is an essential component in patient selection for TTVR. The window for edge-to-edge TTVR might be limited, but timely intervention is an important factor for a better outcome and successful right ventricular reverse remodeling.
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Affiliation(s)
- Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gregor Heitzinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A. Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Anna Bartunek
- Department of Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Philipp E. Bartko
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- *Correspondence: Georg Goliasch
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11
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Kubala M, de Chillou C, Bohbot Y, Lancellotti P, Enriquez-Sarano M, Tribouilloy C. Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward. Front Cardiovasc Med 2022; 9:792559. [PMID: 35242822 PMCID: PMC8885812 DOI: 10.3389/fcvm.2022.792559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.
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Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy, Vandœuvre lès Nancy, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, CHU Sart Tilman, Liège, Belgium
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
- *Correspondence: Christophe Tribouilloy
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12
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Saeed S, Smith J, Grigoryan K, Freitas D, Bleie Ø, Chambers JB, Rajani R. Sex differences in right ventricular systolic function and all-cause mortality in tricuspid regurgitation. Cardiology 2022; 147:453-460. [PMID: 35168238 DOI: 10.1159/000522587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sex-differences have been poorly studied in patients with right-sided heart valve disease. The principal aim of the current study was to explore the impact of sex-differences on right ventricular (RV) hemodynamics and all-cause mortality in patients with moderate or severe tricuspid regurgitation (TR). METHODS This is a retrospective study of 209 patients with significant TR. All patients were clinically profiled at baseline and underwent a transthoracic echocardiogram. The cohort was followed up for clinical events for a median duration of 80 months (mean±SD 69.4±33.4months). RESULTS There were 117 women with a mean (±SD) age of 72.6±13years and 92 men with a mean (±SD) age of 70.8±15.8years. There were no sex-differences between the individual measures of RV systolic function (tricuspid annulus plane systolic excursion [TAPSE], systolic pulmonary artery pressure [SPAP] and RV S'), but overall RV systolic dysfunction (TAPSE <16mm and/or RV S' <10cm/s) and LVEF <50% were more common in men. Mean (±SD) RV wall tension (RVWT) was 3170±1220 mmHg x mm in women and 3817±1499 mmHg x mm in men (p=0.002). There was no difference in all-cause mortality between women and men (Log-Rank p=0.528). Age and increased RVWT were independent predictors of all-cause mortality both in women (HR 2.61) and men (HR 3.01). CONCLUSIONS In this cohort of patients with significant TR, women more frequently had preserved RV systolic function than men. There was no sex-difference in all-cause mortality. An increased RVWT and higher age were independent predictors of all-cause mortality in both women and men.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jenna Smith
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Karine Grigoryan
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Dario Freitas
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B Chambers
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ronak Rajani
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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13
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Wang TKM, Mentias A, Akyuz K, Kirincich J, Crane AD, Popovic ZB, Xu B, Gillinov AM, Pettersson GB, Griffin BP, Desai MY. Effect of Tricuspid Valve Repair or Replacement on Survival in Patients With Isolated Severe Tricuspid Regurgitation. Am J Cardiol 2022; 162:163-169. [PMID: 34903339 DOI: 10.1016/j.amjcard.2021.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023]
Abstract
Controversies remain in the management strategy for isolated tricuspid regurgitation (TR) because of adverse prognosis and uncertainties regarding the benefits of tricuspid valve surgery. We compared the characteristics and outcomes of a large cohort of patients with isolated TR, based on downstream tricuspid valve surgery versus medical management. Consecutive patients with isolated TR graded at least moderate-to-severe by echocardiography identified between January 2004 and December 2018 (n = 9,031, age 70 ± 15 years, 60% women) were retrospectively studied. The primary end point was time to all-cause mortality during follow-up. Outcomes were compared by management strategy using unadjusted and adjusted survival and multivariable regression analyses. Tricuspid valve surgery was performed in 632 of 9,031 of the cohort (7%), including 514 valve repairs and 118 valve replacements, with in-hospital mortality in 19 patients (2.9%). Overall, there were 3,985 all-cause deaths (44%) over mean follow-up of 2.6 ± 3.3 years. Tricuspid valve surgery was independently associated with lower mortality rate during follow-up, with hazard ratios (HRs) of 0.53 (95% confidence interval [CI] 0.45 to 0.64), and the association persisted in both primary and secondary TR subgroups. Tricuspid valve surgery also had a significantly higher rate of infective endocarditis and heart failure hospitalizations rates during follow-up, at HRs of 5.55 (95% CI 4.00 to 7.71) and 1.29 (95% CI 1.16 to 1.43), respectively. In conclusion, tricuspid valve surgery is rarely performed in isolated TR, but it is independently associated with greater survival for the overall cohort and both primary and secondary etiology subgroups. Increasing the utilization of this surgery at specialized centers is encouraged to try to improve the clinical outcomes for this challenging clinical entity.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Kevser Akyuz
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Jason Kirincich
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Alejandro Duran Crane
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Zoran B Popovic
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Alan Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio.
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14
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Contemporary Etiologies, Outcomes, and Novel Risk Score for Isolated Tricuspid Regurgitation. JACC Cardiovasc Imaging 2021; 15:731-744. [PMID: 34922866 DOI: 10.1016/j.jcmg.2021.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The authors report etiologies and outcomes and devise a risk model in a large contemporary cohort of patients with isolated tricuspid regurgitation (TR). BACKGROUND Isolated TR is a challenging clinical entity with heterogeneous etiology and often poor outcomes, with a paucity of recent research regarding the epidemiology of isolated TR. METHODS Consecutive patients with isolated TR graded at least moderate to severe on echocardiography from January 2004 to December 2018 (n = 9,045, mean age 70.4 ± 15.4 years, 60.3% women) were studied. TR etiologies were individually adjudicated as secondary or primary, with subcategories. All-cause death during follow-up was the primary endpoint, with associations between etiology and outcomes analyzed and a risk model created. RESULTS Primary and secondary TR etiologies were present in 470 (5.2%) and 8,575 (94.8%) patients, respectively. The main secondary etiologies were left heart disease in 4,664 (54.4%), atrial functional in 2,086 (24.3%), and pulmonary disease in 1,454 (17.0%), and the main primary etiologies were endocarditis in 222 (47.2%), degenerative or prolapse in 86 (18.3%), and prosthetic valve failure in 79 (16.8%). There were 3,987 deaths (44.0%) over a mean follow-up period of 2.6 ± 3.3 years. In unadjusted analyses, patients with secondary TR had worse survival than those with primary TR (HR: 1.56; 95% CI: 1.32-1.85), but this result was not statistically significant in multivariable analysis. The authors devised and internally validated a risk score for predicting 1-year mortality in these patients. CONCLUSIONS Secondary TR constituted 95% of isolated significant TR and conferred worse survival than primary TR in unadjusted but not adjusted analyses. The present novel risk score stratifies the risk for 1-year death and may influence decision making for management in these high-risk patients.
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15
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Hua K, Zhao R, Peng Z, Yang Y, Florian O, Mao B, Yang X. Early surgery can improve the outcomes of patients with severe tricuspid regurgitation undergoing tricuspid replacement. Cardiovasc Diagn Ther 2021; 11:1058-1066. [PMID: 34815956 DOI: 10.21037/cdt-21-311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
Background Tricuspid regurgitation (TR) usually remains asymptomatic for a long time, such that it is most often diagnosed at an advanced stage of right heart failure. The purpose of this study was to identify clinical characteristics and overall outcomes in patients with severe TR who received tricuspid valve replacement (TVR) at different clinical stages. Methods Between 1993 and 2018, 256 severe TR patients who received TVR alone or in combination with other procedures were assessed at Beijing Anzhen Hospital. Ninety-three patients underwent New York Heart Association (NYHA) class I/II operations (early surgery group), and the others underwent NYHA class III/IV operations. The primary outcome was in-hospital and long-term mortality. Clinical outcomes were evaluated by the Kaplan-Meier method and Cox regression models. Follow-up was conducted annually. Propensity score matching and overlap propensity score weighting were performed as sensitivity analyses. Results Postoperative complications, including low cardiac output (11.8% vs. 26.4%, P<0.001), renal failure (2.2% vs. 16.6%, P<0.001), and bleeding (3.2% vs. 11.7%, P=0.037), were significantly lower in the NYHA class I/II group than in the NYHA III/IV group. Patients in the NYHA class III/IV group had a significantly higher incidence of in-hospital mortality (18.4% vs. 5.4%, P<0.001) and long-term mortality (33.7% vs. 11.8%, P=0.006) after follow-up (median follow-up duration =63 months). The results indicated a consistently higher occurrence rate in the propensity score-matched cohort and overlap propensity score weighted analysis. Conclusions Consistent with the recent clinical trend to provide earlier and more aggressive TR intervention, our results indicate that surgery for severe TR patients should be considered before advanced heart failure develops, when patients are asymptomatic or mildly symptomatic (NYHA class I/II).
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Affiliation(s)
- Kun Hua
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Rui Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Peng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Yunxiao Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Osmanaj Florian
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Bin Mao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Xiubin Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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16
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Javed N, Iqbal R, Malik J, Rana G, Akhtar W, Zaidi SMJ. Tricuspid insufficiency after cardiac-implantable electronic device placement. J Community Hosp Intern Med Perspect 2021; 11:793-798. [PMID: 34804393 PMCID: PMC8604508 DOI: 10.1080/20009666.2021.1967569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Device-related estimates of incidence and significance of tricuspid regurgitation (TR) is mainly based on case reports and small observational studies. We sought to determine whether right-heart device implantation increased the risk of TR in this interventional study. Methods All patients who underwent permanent pacemaker (PPM) or other device implantation were assessed for degree of TR at one year. The data collected was analyzed on IBM SPSS version 26. Descriptive statistics were applied for qualitative variables. Mean and standard deviation were applied for quantitative variables. Regression analysis and paired t-tests were applied for the degree of change and predictors of TR. Results Out of 165 participants, 73.94% were male. The mean age of the participants was 59.86 ± 12.03 years. Dual-chamber pacemaker (DDDR) was the most common device implanted (78.18%) causing significant TR and drop in left ventricular ejection fraction as compared to other devices (p-value < 0.05). The paired t-test for changes in ejection fraction (LVEF) and TR were also significant (p-value < 0.05). A regression model predicted significant TR to depend on baseline LVEF (p-value < 0.05). Conclusion Device-related worsening of TR is related to mechanical mechanisms. It is significantly associated with DDDR pacemakers after a 1-year follow-up.
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Affiliation(s)
- Nismat Javed
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Raafe Iqbal
- Department of Cardiology, Pakistan Ordinances Factory Hospital, Wah Cantt, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Ghazanfar Rana
- Department of Cardiology, St. Lukes General Hospital, Kilkenny, Ireland
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
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17
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Tabucanon RS, Wang TKM, Chetrit M, Furqan MM, Chan N, Pande A, Jellis CL, Cremer PC, Kwon DH, Johnston D, Klein AL. Worsened Tricuspid Regurgitation Following Pericardiectomy for Constrictive Pericarditis. Circ Cardiovasc Imaging 2021; 14:e012948. [PMID: 34607446 DOI: 10.1161/circimaging.121.012948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Worsening tricuspid regurgitation (TR) severity may occur after pericardiectomy surgery for constrictive pericarditis patients; however, its mechanisms and predictors are not well established. We evaluated the clinical characteristics, associated factors, and outcomes of worsening TR after pericardiectomy. METHODS Consecutive patients undergoing pericardiectomy for constrictive pericarditis without tricuspid valve surgery and with pre- and postoperative echocardiography available during 2000 to 2017 were retrospectively studied. Clinical, imaging, hemodynamic, and mortality characteristics were analyzed by those with and without worsening TR by at least one grade. RESULTS Among 381 patients (age 61 [17] years, 318 [83.5%] male), 193 (50.7%) had worsening TR post-operatively, and 75 died during the 2.5 (5.4) years follow-up. In univariable analysis, worsening TR was associated with a history of congestive heart failure (47.2% versus 31.9%, P=0.003), increased left atrial volume indexed (23 versus 20 mL/m2, P=0.020), reduced right ventricular fractional area change (47% versus 54%, P<0.001), and worsening mitral regurgitation (39.7% versus 16.6%, P<0.001). Worsened TR had a trend toward reduced survival during follow-up (log-rank P=0.080), especially those with worsened TR but no recovery of TR grade on subsequent echocardiography within the first year compared with those without worsened TR (log-rank P=0.02). In multivariable analysis, right ventricular fractional area change, left atrial volume indexed, left ventricular mass indexed, pulmonary artery systolic pressure, and right atrial pressure/pulmonary capillary wedge pressure ratio were most associated with worsened TR, while blood urea nitrogen, hematocrit, lateral and medial e' tissue Doppler and heart rate were most associated with mortality during follow-up. CONCLUSIONS Worsening TR severity was prevalent after pericardiectomy and had a trend toward reduced survival, especially if TR severity did not recover on subsequent echocardiography. Presence of parameters associated with worsened TR and reduced survival should alert clinicians to carefully manage these patients during follow-up.
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Affiliation(s)
- Ray S Tabucanon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Michael Chetrit
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Muhammad M Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Nicholas Chan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Amol Pande
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Christine L Jellis
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Douglas Johnston
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
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18
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Schlossbauer SA, Faletra FF, Paiocchi VL, Leo LA, Franciosi G, Bonanni M, Angelini G, Pavon AG, Ferrari E, Ho SY, Hahn RT. Multimodality Imaging of the Anatomy of Tricuspid Valve. J Cardiovasc Dev Dis 2021; 8:jcdd8090107. [PMID: 34564125 PMCID: PMC8469874 DOI: 10.3390/jcdd8090107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Even though the tricuspid valve is no longer “forgotten”, it still remains poorly understood. In this review, we focus on some controversial and still unclear aspects of tricuspid anatomy as illustrated by noninvasive imaging techniques. In particular, we discuss the anatomical architecture of the so-called tricuspid annulus with its two components (i.e., the mural and the septal annulus), emphasizing the absence of any fibrous “ring” around the right atrioventricular junction. Then we discussed the extreme variability in number and size of leaflets (from two to six), highlighting the peculiarities of the septal leaflet as part of the septal atrioventricular junction (crux cordis). Finally, we describe the similarities and differences between the tricuspid and mitral valve, suggesting a novel terminology for tricuspid leaflets.
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Affiliation(s)
- Susanne Anna Schlossbauer
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Francesco Fulvio Faletra
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
- Correspondence: ; Tel.: +41-91-805-3179; Fax: +41-91-805-3167
| | - Vera Lucia Paiocchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Laura Anna Leo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Giorgio Franciosi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Michela Bonanni
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Gianmarco Angelini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London SW36NP, UK;
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA;
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19
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Tadic M, Cuspidi C, Morris DA, Rottbauer W. Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure? Heart Fail Rev 2021; 27:1301-1312. [PMID: 34264478 PMCID: PMC9197807 DOI: 10.1007/s10741-021-10141-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany.
| | | | - Daniel Armando Morris
- Department of Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Wolfang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany
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20
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Dietz MF, Prihadi EA, van der Bijl P, Fortuni F, Marques AI, Ajmone Marsan N, Bax JJ, Delgado V. Sex-Specific Differences in Etiology and Prognosis in Patients With Significant Tricuspid Regurgitation. Am J Cardiol 2021; 147:109-115. [PMID: 33640367 DOI: 10.1016/j.amjcard.2021.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 01/31/2023]
Abstract
The aim of this study was to assess differences in etiology, comorbidities, echocardiographic parameters, and prognosis between men and women with significant tricuspid regurgitation (TR). Clinical and echocardiographic characteristics of 1569 patients (age 71 [62 to 78] years) at first diagnosis of significant TR were compared between men and women. Patients with congenital heart disease or previous tricuspid valve surgery were excluded. TR etiologies were defined as primary, left valvular disease related, left ventricular (LV) dysfunction related, pulmonary hypertension related, or isolated. The primary endpoint was all-cause mortality. Sex-specific differences in outcomes were compared in the total population and after propensity score matching. There were 798 (51%) women and 771 (49%) men in the study population. Women were diagnosed with significant TR at an older age compared with men (72 [62 to 79] years vs. 70 [61 to 77] years; p = 0.003). The TR etiology in women was more often left valvular disease related and isolated whereas men more often had LV dysfunction related TR. In the total population women had better 10-year survival compared with men (49% vs. 39%; p=0.001). After propensity score matching, the influence of sex on survival was neutralized (p = 0.228) but the TR etiologies remained significantly associated with all-cause mortality. Patients with left valvular disease or LV dysfunction related TR had lower survival compared with patients with primary TR (p = 0.004 and p = 0.019, respectively). In conclusion, long-term survival of patients with significant TR was similar between men and women after propensity score matching, while the etiology of TR remained significantly associated with all-cause mortality.
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Affiliation(s)
- Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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21
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Barker CM, Cork DP, McCullough PA, Mehta HS, Van Houten J, Gunnarsson C, Ryan M, Irish W, Mollenkopf S, Verta P. Comparison of Survival in Patients With Clinically Significant Tricuspid Regurgitation With and Without Heart Failure (From the Optum Integrated File). Am J Cardiol 2021; 144:125-130. [PMID: 33385352 DOI: 10.1016/j.amjcard.2020.12.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
This study aimed to quantify survival rates for patients with tricuspid regurgitation (TR) using real-world data. Several clinical conditions are associated with TR, including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser co-morbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared with patients with TR alone. TR severity was also significantly associated (hazard ratio = 1.33; p = 0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD before their TR diagnosis.
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Affiliation(s)
- Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, California
| | | | | | | | - William Irish
- Brody School of Medicine, Greenville, North Carolina
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22
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Barker CM, Cork DP, McCullough PA, Mehta HS, Houten JV, Gunnarsson C, Mollenkopf S, Verta P. Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure. J Comp Eff Res 2020; 10:29-37. [PMID: 33174767 DOI: 10.2217/cer-2020-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluated how the presence of right-sided heart disease (RSHD), other valve disease (OVD) and heart failure (HF) impacts healthcare utilization in patients with tricuspid valve disease (tricuspid regurgitation [TR]). Materials & methods: Of the 33,686 patients with TR: 6618 (19.6%) had TR-only; 8952 (26.6%) had TR with HF; 12,367 (36.7%) had TR with OVD but no HF; and 5749 (17.1%) had TR with RSHD only. Results: The presence of RSHD, OVD or HF in patients with TR was independently associated with increased annualized hospitalizations, hospital days and costs relative to patients with TR alone. Conclusion: All three co-morbidities were associated with increased healthcare utilization, with HF showing the greatest impact across all measures.
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Affiliation(s)
- Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart & Vascular Institute, Baylor Jack & Jane Hamilton Heart & Vascular Hospital, Dallas, TX, USA
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Advanced Heart Failure, San Diego, CA, USA
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23
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Peugnet F, Bohbot Y, Chadha G, Delpierre Q, Kubala M, Delabre J, Landemaine T, Beyls C, Tribouilloy C. Improvement of the Prognosis Assessment of Severe Tricuspid Regurgitation by the Use of a Five-Grade Classification of Severity. Am J Cardiol 2020; 132:119-125. [PMID: 32741538 DOI: 10.1016/j.amjcard.2020.06.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
It is well known that some patients present with "more than severe" tricuspid regurgitation (TR). We aimed to assess the prognosis of these very severe TR patients. We defined very severe TR using 3 simple echocardiographic parameters: a coaptation gap≥10mm, a laminar TR flow and a systolic reversal of the hepatic vein flow. We included 259 consecutive patients (76 ± 13 years; 46% men) with moderate-to-severe TR (n = 114) and severe TR (n = 145). The primary end point was the combination of hospitalisation for right heart failure (RHF) and cardiovascular mortality. Median follow-up was 24(7 to 47) months. In patients with severe TR, 52 (36%) met the definition of very severe TR. These patients were younger, had more history of RHF and were more frequently treated with loop diuretics than those with moderate-to-severe TR (all p < 0.001). Four-year event-free survival rates were 68 ± 5%, for moderate-to-severe TR, 48 ± 6% for severe TR and only 35 ± 7% for very-severe TR (p < 0.001). On multivariable analysis, after adjustment for outcome predictors including age, comorbidity, RHF, TR etiology, left and right ventricular dysfunction, and tricuspid valve surgery, patients with very severe TR had a worsened prognosis than those with moderate-to-severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.43 [1.18 to 5.53]; p = 0.002) and than those with severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.23 [1.06 to 5.56]; p = 0.015). In conclusion, very severe TR is frequent in patients with severe TR, corresponds to a more advanced stage of the disease and is associated with poor outcomes. Therefore, the use of a 5-grade classification of TR severity is justified in routine clinical practice. (ID-RCB: 2017-A03233-50).
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24
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Zaky AF, Berkowitz DE. Mythical metrics and methods: Needed paradigm shift in disease recognition and therapy. Med Hypotheses 2020; 141:109734. [PMID: 32298922 DOI: 10.1016/j.mehy.2020.109734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
Current medicine is practiced in an organ-based, function-appraised manner with less attention paid to the tissue characteristics of the appraised organs. The fundamentals of this paradigm have been the product of an oversimplified and often layman-based perceptions of the studied organ over the years. These perceptions drove the current definitions of normality and abnormality, parameters used in the diagnosis of the disease, goals of treatment and studied outcomes. Despite the explosive advancement in technology that could have potentially changed our 'upstream' thinking, practitioners remain captives of these old beliefs and have streamlined current technology in a 'downstream' fashion; in the form of goal-directed protocols, and engineering systems that would study their implementations. As a result, diseases continue to evolve, become more resistant to therapy, late to diagnose, and with a persistent worsening of outcomes. With a primarily focus on the heart and from an anesthesiologist prospective, we challenge the fundamentals of the current paradigm from an 'upstream' prospective. We challenge the current 'territorial' definitions of the organs studied, the current terminology of some diseases, the parameters used in their diagnosis, the diagnostic modalities used and their goals of treatment. We illustrate some examples when the current collective 'myth' meets the 'reality' in an acute care setting, further clarifying the limitations of the current paradigm. We also, provide a theoretical hypothesis of what we believe to be a potential substitute of the current paradigm. Our theory redefines disease from an organ-based functional phenomenon to a structural-based tissue phenomenon, calling for an integrative and holistic approach of tissue assessment rather than a discrete approach that may potentially obscure the interaction of non-appraised organs. We also believe in redirecting technology in an upstream direction to better redefine and early detect diseases rather than submitting to generationally inherited beliefs. Whereas we have started some of our research on our proposed paradigm, our theoretical framework remains to be thought-provoking, and hypothesis-generating at the present time.
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Affiliation(s)
- Ahmed F Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States.
| | - Dan E Berkowitz
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States
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