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Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Lee S, Sun BJ, Yoon SJ, Lee SH, Kim HY, Kim HM, Park JH, Hong GR, Jung HO, Kim YJ, Kim KH, Kang DH, Ha JW, Kim H. 2023 Korean Society of Echocardiography position paper for the diagnosis and management of valvular heart disease, part II: mitral and tricuspid valve disease. J Cardiovasc Imaging 2024; 32:10. [PMID: 38951920 PMCID: PMC11218416 DOI: 10.1186/s44348-024-00021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/30/2023] [Indexed: 07/03/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to present recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.
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Affiliation(s)
- Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Hwa Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
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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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3
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Berbarie RF. Fitting More Pieces Into The Puzzle Of Diagnosing Severe Tricuspid Valve Regurgitation. Am J Cardiol 2024; 215:68-69. [PMID: 38007070 DOI: 10.1016/j.amjcard.2023.11.016] [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: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Rafic F Berbarie
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Grapsa J, Praz F, Sorajja P, Cavalcante JL, Sitges M, Taramasso M, Piazza N, Messika-Zeitoun D, Michelena HI, Hamid N, Dreyfus J, Benfari G, Argulian E, Chieffo A, Tchetche D, Rudski L, Bax JJ, Stephan von Bardeleben R, Patterson T, Redwood S, Bapat VN, Nickenig G, Lurz P, Hausleiter J, Kodali S, Hahn RT, Maisano F, Enriquez-Sarano M. Tricuspid Regurgitation: From Imaging to Clinical Trials to Resolving the Unmet Need for Treatment. JACC Cardiovasc Imaging 2024; 17:79-95. [PMID: 37731368 DOI: 10.1016/j.jcmg.2023.08.013] [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: 07/20/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent and heterogeneous valvular disease, independently associated with excess mortality and high morbidity in all clinical contexts. TR is profoundly undertreated by surgery and is often discovered late in patients presenting with right-sided heart failure. To address the issue of undertreatment and poor clinical outcomes without intervention, numerous structural tricuspid interventional devices have been and are in development, a challenging process due to the unique anatomic and physiological characteristics of the tricuspid valve, and warranting well-designed clinical trials. The path from routine practice TR detection to appropriate TR evaluation, to conduction of clinical trials, to enriched therapeutic possibilities for improving TR access to treatment and outcomes in routine practice is complex. Therefore, this paper summarizes the key points and methods crucial to TR detection, quantitation, categorization, risk-scoring, intervention-monitoring, and outcomes evaluation, particularly of right-sided function, and to clinical trial development and conduct, for both interventional and surgical groups.
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Affiliation(s)
- Julia Grapsa
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom.
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Joao L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomedica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Nicolo Piazza
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - David Messika-Zeitoun
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA; Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Edgar Argulian
- Cardiology Department, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tiffany Patterson
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Simon Redwood
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Susheel Kodali
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Francesco Maisano
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele University Hospital, Milan, Italy
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Molnár AÁ, Sánta A, Merkely B. Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography. Diagnostics (Basel) 2023; 13:2470. [PMID: 37568832 PMCID: PMC10416971 DOI: 10.3390/diagnostics13152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (A.S.); (B.M.)
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Welker CC, Huang J, Khromava M, Boswell MR, Gil IJN, Ramakrishna H. Analysis of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for the Management of Valvular Heart Disease. J Cardiothorac Vasc Anesth 2023; 37:803-811. [PMID: 36775745 DOI: 10.1053/j.jvca.2023.01.008] [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: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Carson C Welker
- Division of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey Huang
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Iván J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Biomedical Science Faculty, Universidad Europea de Madrid, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, MN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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7
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Tricuspid Regurgitation in Acute Heart Failure: Predicting Outcome Using Novel Quantitative Echocardiography Techniques. Diagnostics (Basel) 2022; 13:diagnostics13010109. [PMID: 36611401 PMCID: PMC9818460 DOI: 10.3390/diagnostics13010109] [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: 11/21/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background: The prognostic impact of tricuspid regurgitation (TR) in acute heart failure (AHF) remains uncertain. Methods: We retrospectively assessed 418 consecutive AHF patients who underwent comprehensive echocardiographic assessment within 24 h of study recruitment. TR was quantitatively assessed with 3 guideline-directed measures: regurgitant volumes (RgVol), effective regurgitant orifice area (ERO) and vena contracta (VC) diameter. Disproportionate TR was assessed by the ratio of the VC diameter to the tricuspid annulus diameter (VC/TA) ≥ 0.24. Results: The prevalence of significant (i.e., >mild) TR differed when various standard assessment parameters were applied to quantification: RgVol 50.3% (173/344), ERO 75.6% (260/344) and VC diameter 94.6% (335/354). None were able to delineate those at excess risk of all-cause 2-year mortality using guideline-directed cut-offs of mild, moderate and severe TR. Using a cut-off of VC/TA ≥ 0.24, we identified that 36.9% (130/352) had “disproportionate” TR. Disproportionate TR was associated with an excess risk of mortality at 2 years compared to proportionate TR; HR 1.48 (95% CI 1.06−2.06 [p = 0.02]) which was not significant on multivariate assessment (p = 0.94). Conclusions: TR was not associated with outcome in AHF using guideline measures. A new assessment of “Disproportionate” TR carries a higher risk than proportionate TR but was not related to outcome based on multivariate analysis. Further research is needed to quantify TR more effectively to identify cut-offs for future guidelines and disproportionate TR may be an important part of Heart Failure 2.0.
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8
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Chon MK, Lee SW, Hahn JY, Park YH, Kim HS, Lee SH, Shin DH, Lee PH, Kim EK, Lee JH, Park JH, Choi YJ, Reinthaler M, Barbieri F, Park JW, Park J, Kim JH. A Novel Device for Tricuspid Regurgitation Reduction Featuring 3-Dimensional Leaflet and Atraumatic Anchor: Pivot-TR System. JACC Basic Transl Sci 2022; 7:1249-1261. [PMID: 36644275 PMCID: PMC9831928 DOI: 10.1016/j.jacbts.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/06/2022]
Abstract
A new device called the Pivot-TR system was designed to treat tricuspid regurgitation with a novel spacer crossing the valve vertically. Its unique atraumatic anchoring system composed of both the elephant long nose and the inferior vena cava spiral anchor, in addition to the relatively easy implantation mechanism, enabled easy retrieval of the system later on. The system showed promising feasibility and safety results in this swine-based animal experiment, which should encourage human translation study.
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Affiliation(s)
- Min-Ku Chon
- Department of Cardiology, School of Medicine, Pusan National University and Cardiovascular Center, Yagnas Hospital, Yangsan, South Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-Hyun Park
- Department of Cardiology, School of Medicine, Pusan National University and Cardiovascular Center, Yagnas Hospital, Yangsan, South Korea
| | - Hyun-Sook Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sang-Hyun Lee
- Department of Cardiology, School of Medicine, Pusan National University and Cardiovascular Center, Yagnas Hospital, Yangsan, South Korea
| | - Dong-Hoon Shin
- Department of Pathology, School of Medicine, Pusan National University, Yangsan Hospital, Yangsan, South Korea
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University Sejong Hospital, School of Medicine, Chungnam National University, Sejong, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Young Jin Choi
- Department of Cardiology, Sejong General Hospital, Bucheon, South Korea
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Fabian Barbieri
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Jai-Wun Park
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Junhui Park
- Department of Statistics and Data Science, Yonsei University, South Korea
| | - June-Hong Kim
- Department of Cardiology, School of Medicine, Pusan National University and Cardiovascular Center, Yagnas Hospital, Yangsan, South Korea
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Tomaselli M, Badano LP, Menè R, Gavazzoni M, Heilbron F, Radu N, Caravita S, Baratto C, Oliverio G, Florescu DR, Parati G, Muraru D. Impact of correcting the 2D PISA method on the quantification of functional tricuspid regurgitation severity. Eur Heart J Cardiovasc Imaging 2022; 23:1459-1470. [PMID: 35734964 DOI: 10.1093/ehjci/jeac104] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS In functional tricuspid regurgitation (FTR) patients, tricuspid leaflet tethering and relatively low jet velocity could result in proximal flow geometry distortions that lead to underestimation of TR. Application of correction factors on two-dimensional (2D) proximal isovelocity surface area (PISA) equation may increase its reliability. This study sought to evaluate the impact of the corrected 2D PISA method in quantifying FTR severity. METHODS AND RESULTS In 102 patients with FTR, we compared both conventional and corrected 2D PISA measurements of effective regurgitant orifice area [EROA vs. corrected (EROAc)] and regurgitant volume (RegVol vs. RegVolc) with those obtained by volumetric method (VM) using three-dimensional echocardiography (3DE), as reference. Both EROAc and RegVolc were larger than EROA (0.29 ± 0.26 vs. 0.22 ± 0.21 cm2; P < 0.001) and RegVol (24.5 ± 20 vs. 18.5 ± 14.25 mL; P < 0.001), respectively. Compared with VM, both EROAc and RegVolc resulted more accurate than EROA [bias = -0.04 cm2, limits of agreement (LOA) ± 0.02 cm2 vs. bias = -0.15 cm2, LOA ± 0.31 cm2] and RegVol (bias = -3.29 mL, LOA ± 2.19 mL vs. bias = -10.9 mL, LOA ± 13.5 mL). Using EROAc and RegVolc, 37% of patients were reclassified in higher grades of FTR severity. Corrected 2D PISA method led to a higher concordance of TR severity grade with the VM method (ĸ = 0.84 vs. ĸ = 0.33 for uncorrected PISA, P < 0.001). CONCLUSION Compared with VM by 3DE, the conventional PISA underestimated FTR severity in about 50% of patients. Correction for TV leaflets tethering angle and lower velocity of FTR jet improved 2D PISA accuracy and reclassified more than one-third of the patients.
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Affiliation(s)
- Michele Tomaselli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Noela Radu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giorgio Oliverio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Diana R Florescu
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy.,University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Singulane CC, Singh A, Addetia K, Yamat M, Lang RM. Developing Insights Regarding Tricuspid Valve Regurgitation: Morphology, Assessment of Severity, and the Need for a Novel Grading Scheme. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100026. [PMID: 37273466 PMCID: PMC10236825 DOI: 10.1016/j.shj.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/17/2022] [Indexed: 06/06/2023]
Abstract
Current understanding that progressive tricuspid regurgitation (TR) is associated with worse outcomes has highlighted the clinical need for a more accurate assessment of TR morphology and severity. This need has been further emphasized owing to the development of a myriad of percutaneous right-sided interventions, which may offer successful treatment of TR in selected patients. Understanding the etiology and quantification of the severity of TR has important implications in the selection of novel therapeutic strategies, i.e., medical vs. percutaneous vs. surgical approaches. Newer grading schemas that better reflect the TR lesion severity have been recently proposed and may facilitate monitoring of the evolution of TR following percutaneous and/or surgical treatment. In this review, we summarize contemporary concepts regarding tricuspid valve morphology, TR etiology, and associated mechanisms and echocardiographic approaches to grade TR severity.
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Affiliation(s)
| | | | | | | | - Roberto Miguel Lang
- Address correspondence to: Roberto Miguel Lang, MD, FASE, FACC, The University of Chicago Medicine, 5758 S. Maryland Avenue, MR 9067, DCAM 5509, Chicago, IL 6063
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Predominant Posterior Annular Dilatation is Associated With Vena Contracta Morphology in Atrial Functional Tricuspid Regurgitation. J Am Soc Echocardiogr 2022; 35:588-599. [DOI: 10.1016/j.echo.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/23/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022]
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14
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Volpato V, Badano LP, Figliozzi S, Florescu DR, Parati G, Muraru D. Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve. Curr Opin Cardiol 2021; 36:513-524. [PMID: 34292179 PMCID: PMC9904443 DOI: 10.1097/hco.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers. RECENT FINDINGS Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians. SUMMARY This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
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Affiliation(s)
- Valentina Volpato
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Stefano Figliozzi
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Diana R. Florescu
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
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16
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2252] [Impact Index Per Article: 750.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Muraru D, Previtero M, Ochoa-Jimenez RC, Guta AC, Figliozzi S, Gregori D, Bottigliengo D, Parati G, Badano LP. Prognostic validation of partition values for quantitative parameters to grade functional tricuspid regurgitation severity by conventional echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:155-165. [PMID: 33247930 DOI: 10.1093/ehjci/jeaa282] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Quantitative echocardiography parameters are seldom used to grade tricuspid regurgitation (TR) severity due to relative paucity of validation studies and lack of prognostic data. To assess the relationship between TR severity and the composite endpoint of death and hospitalization for congestive heart failure (CHF); and to identify the threshold values of vena contracta width (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFr) to define low, intermediate, and high-risk TR based on patients' outcome data. METHODS AND RESULTS A cohort of 296 patients with at least mild TR underwent 2D, 3D, and Doppler echocardiography. We built statistical models (adjusted for age, NYHA class, left ventricular ejection fraction, and pulmonary artery systolic pressure) for VCavg, EROA, RegVol, and RegFr to study their relationships with the hazard of outcome. The tertiles of the derived hazard values defined the threshold values of the quantitative parameters for TR severity grading. During 47-month follow-up, 32 deaths and 72 CHF occurred. Event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild TR, respectively. Severe TR was graded as VCavg > 6 mm, EROA > 0.30 cm2, RegVol > 30 mL, and RegF > 45%. CONCLUSION This outcome study demonstrates the prognostic value of quantitative parameters of TR severity and provides prognostically meaningful threshold values to grade TR severity in low, intermediate, and high risk.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Marco Previtero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Roberto C Ochoa-Jimenez
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy.,Internal Medicine Department, Mount Sinai St. Luke's and Mount Sinai West, New York, NY 10019, USA
| | - Andrada C Guta
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy.,Department of Internal Medicine and Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest 030167, Romania
| | - Stefano Figliozzi
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Daniele Bottigliengo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Luigi P Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
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18
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Dynamic Systolic Changes in Tricuspid Regurgitation Vena Contracta Size and Proximal Isovelocity Surface Area in Hypoplastic Left Heart Syndrome: A Three-Dimensional Color Doppler Echocardiographic Study. J Am Soc Echocardiogr 2021; 34:877-886. [PMID: 33753189 DOI: 10.1016/j.echo.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/24/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal. METHODS Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes. RESULTS In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%. CONCLUSIONS In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation-associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.
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19
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Mah K, Khoo NS, Tham E, Yaskina M, Maruyama M, Martin BJ, Alvarez S, Alami N, Rebeyka IM, Smallhorn J, Colen T. Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome: Three-Dimensional Echocardiography Provides Additional Information in Describing Jet Location. J Am Soc Echocardiogr 2020; 34:529-536. [PMID: 33373699 DOI: 10.1016/j.echo.2020.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Twenty-five percent of patients with hypoplastic left heart syndrome (HLHS) require tricuspid valve (TV) repair. The location of tricuspid regurgitation (TR) is important in determining the type of repair performed. Studies using three-dimensional echocardiography (3DE) have reported a high incidence of error on two-dimensional echocardiography (2DE) for the identification of TV leaflets. The aim of this study was to compare assessment of TR on 3DE and 2DE in patients with HLHS (jet location, TR grade, and reproducibility). METHODS A retrospective, single-center review was performed. Fifty-six patients with HLHS with available two-dimensional and three-dimensional echocardiograms, and mild or greater TR, were included. TR location, grade, vena contracta area, and TV annular diameter were measured on 2DE and 3DE. Reproducibility was assessed by blinded reviewers. RESULTS Three-dimensional echocardiography identified the primary jet location as central (57%) followed by anteroseptal (36%). There was poor agreement between findings on 3DE and 2DE for jet location (κ = 0.05; 95 CI, -0.08 to 0.19). Interobserver reproducibility for location on 3DE was excellent (κ = 0.8), whereas reproducibility for 2DE was poor (κ = 0.32). The most common jet location pre-Norwood and pre-Glenn was central (70%), whereas pre-Fontan and post-Fontan, jet location was central (45%) and anteroseptal (48%). Vena contracta area on 2DE correlated moderately with vena contracta area on 3DE (r = 0.60, P < .0001). TV annular diameters on 2DE and 3DE for lateral (r = 0.85, P < .0001) and anteroposterior (r = 0.74, P = .001) dimensions were strongly correlated. CONCLUSIONS In children with HLHS, assessment of TR location on 2DE had poor agreement with assessment on 3DE and was poorly reproducible. In contrast, TR jet location on 3DE was highly reproducible. Pre-Glenn, a central TR jet was the most common, while post-Glenn, central and anteroseptal locations were equal, highlighting the importance of preoperative identification of TR jet location in patients with HLHS.
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Affiliation(s)
- Kandice Mah
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nee Scze Khoo
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edythe Tham
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michiko Maruyama
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - Silvia Alvarez
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nassiba Alami
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ivan M Rebeyka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Smallhorn
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy Colen
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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20
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Liu Y, Chen B, Zhang Y, Zuo W, Li Q, Jin L, Kong D, Pan C, Dong L, Shu X, Ge J. Sources of Variability in Vena Contracta Area Measurement for Tricuspid Regurgitation Severity Grading: Comparison of Technical Settings and Vendors. J Am Soc Echocardiogr 2020; 34:270-278.e1. [PMID: 33166630 DOI: 10.1016/j.echo.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies found different cutoffs of vena contracta area (VCA) to define severe tricuspid regurgitation (TR). The aim of this study was to investigate the factors associated with such variability by comparing technical variables and vendors. METHODS Sixty-nine patients with scheduled tricuspid surgery were included in this prospective study. For each patient, TR data sets were obtained on three-dimensional color Doppler transthoracic echocardiography on at least two of three systems: GE Vivid E95 (n = 39), Siemens SC2000 Prime (n = 64), and Philips EPIQ 7C (n = 60). VCA was measured using default settings or with color baseline shifted on all three platforms and with minimal color gain (10%-20%) on the GE platform. RESULTS Color gain reduction and baseline shift caused significant change sin VCA measurement (-46% and 10%, respectively). Intervendor comparison exhibited wide limits of agreement (narrowest range, -74% to 167%), with either default or optimized settings. Different technical settings, platforms, and reference methods all produced different VCA cutoffs for severe TR. CONCLUSIONS VCA measurement in TR is sensitive to technical factors and demonstrates intervendor variability. Technical variables in VCA measurement should be reported in detail to allow comparison among research studies. The same vendor and settings should be used for longitudinal analysis of TR VCA in the same patient in multivendor echocardiography laboratories.
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Affiliation(s)
- Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Beiqi Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Wuxu Zuo
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Quan Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ling Jin
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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Hoffmeister KJ, Henderson ZT, Hussey PT, Wu IY. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Focused Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2020; 34:2740-2753. [DOI: 10.1053/j.jvca.2019.11.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
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23
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Nguyen TH, Rudski LG. Optimal Echocardiographic Approach to the Evaluation of Tricuspid Regurgitation. Curr Cardiol Rep 2020; 22:108. [DOI: 10.1007/s11886-020-01367-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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24
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Manzoor I, Gilani SA, Bacha R, Fatima M. Association of spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. J Ultrason 2020; 20:e111-e115. [PMID: 32609961 PMCID: PMC7409541 DOI: 10.15557/jou.2020.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation. Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation.
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Affiliation(s)
- Iqra Manzoor
- University Institute of Radiological Sciences and Medical Imaging Technologies, The University of Lahore , Lahore , Pakistan
| | - Syed Amir Gilani
- Dean Faculty of Allied Health Sciences, The University of Lahore , Lahore , Pakistan
| | - Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technologies, Faculty of Allied Health Sciences, The University of Lahore , Lahore , Pakistan
| | - Mehreen Fatima
- University Institute of Radiological Sciences and Medical Imaging Technologies, Faculty of Allied Health Sciences, The University of Lahore , Lahore , Pakistan
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25
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Chouchani M, Michaelsen J, Langenbrink L, Piatkowski M, Altiok E, Hoffmann R. Quantification of tricuspid regurgitation area by 3-dimensional color Doppler echocardiography considering different clinical settings. Echocardiography 2020; 37:1120-1129. [PMID: 32562588 DOI: 10.1111/echo.14765] [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: 01/02/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The precise assessment of tricuspid regurgitation (TR) using 2D imaging techniques may be associated with significant difficulties due to the nonround regurgitation area. Direct analysis of the regurgitation area by 3D color Doppler echocardiography at the vena contracta (3D VCA) has the potential to adequately quantify even complex TR. This study compared 3D VCA for quantification of the TR with the regurgitant area determined by proximal isovolumetric convergence method (PISA-EROA) considering different clinical settings. METHODS In 95 patients with TR of different severity, the regurgitant orifice area was determined by 3D color Doppler echocardiography and by PISA-EROA. Using 3D color Doppler echocardiography, the regurgitant orifice area was determined three times in each patient considering 3 datasets. RESULTS Mean 3D VCA was 0.27 ± 0.14, 0.27 ± 0.13, and 0.29 ± 0.14 cm2 , respectively, as determined by three separate measurements in each of the 95 patients. There was a mean relative deviation between the three measurements in each patient of 12.4 ± 14.9%. The regurgitant orifice area using the PISA method was 0.28 ± 0.14 cm2 . There was a mean difference of 0.07 cm2 (95% CI -0.124 to 0.138 cm2 ) between 3D VCA and PISA-EROA. The correlation between 3D VCA and PISA-EROA was r = .88 (P < .001). Considering a grading of TR severity in grade I (regurgitant area < 0.2 cm2 ), grade II (area 0.2-0.4 cm2 ), and grade III (area > 0.4 cm2 ), there was a good agreement between severity grade determined by 3D VCA and severity grade determined by PISA-EROA (kappa 0.71). CONCLUSION The analysis of the VCA of a TR using 3D color Doppler echocardiography is an alternative method to determine the regurgitant severity with good agreement to the PISA method.
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Affiliation(s)
- Mehrez Chouchani
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Lukas Langenbrink
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Michal Piatkowski
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Ertunc Altiok
- Department of Cardiology, University RWTH Aachen, Aachen, Germany
| | - Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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27
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Winkel MG, Brugger N, Khalique OK, Gräni C, Huber A, Pilgrim T, Billinger M, Windecker S, Hahn RT, Praz F. Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions. Front Cardiovasc Med 2020; 7:60. [PMID: 32432125 PMCID: PMC7214677 DOI: 10.3389/fcvm.2020.00060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.
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Affiliation(s)
- Mirjam G. Winkel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Omar K. Khalique
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Rebecca T. Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Fabien Praz
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
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28
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Yucel E, Bertrand PB, Churchill JL, Namasivayam M. The tricuspid valve in review: anatomy, pathophysiology and echocardiographic assessment with focus on functional tricuspid regurgitation. J Thorac Dis 2020; 12:2945-2954. [PMID: 32642207 PMCID: PMC7330354 DOI: 10.21037/jtd.2020.02.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The tricuspid valve (TV) is a complex anatomical structure that incorporates a saddle-shaped annulus, asymmetric leaflets, the subvalvular apparatus and the right ventricle and its loading conditions. In this paper, an appreciation of the normal anatomy and physiology of the TV is reviewed before discussing functional tricuspid regurgitation (TR), a disease that has garnered renewed interest due to increased awareness of adverse outcomes and novel transcatheter therapeutic options. Two and three-dimensional echocardiographic imaging of the TV using transthoracic and transesophageal windows are subsequently discussed. The future of cardiovascular medicine will have more to offer the “forgotten” right-sided chambers and valves, and this review aims to refresh knowledge and enthusiasm around the forgotten but crucially important TV.
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Affiliation(s)
- Evin Yucel
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philippe B Bertrand
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica L Churchill
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mayooran Namasivayam
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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29
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Utsunomiya H, Itabashi Y, Kobayashi S, Rader F, Siegel RJ, Shiota T. Clinical Impact of Size, Shape, and Orientation of the Tricuspid Annulus in Tricuspid Regurgitation as Assessed by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2020; 33:191-200.e1. [DOI: 10.1016/j.echo.2019.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
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30
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Avoiding Mistakes of the Past with Tricuspid Regurgitation. J Am Soc Echocardiogr 2019; 32:1547-1550. [DOI: 10.1016/j.echo.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
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31
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Assessment and procedural guidance with echocardiography for transcatheter tricuspid regurgitation devices. Prog Cardiovasc Dis 2019; 62:452-458. [DOI: 10.1016/j.pcad.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
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32
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Zhong Y, Bai W, Wang H, Tang H, Rao L. Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up. Int J Cardiovasc Imaging 2019; 36:257-268. [DOI: 10.1007/s10554-019-01705-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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33
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Maslow A, Abisse S, Parikh L, Apruzzese P, Cilia L, Gleason P, Singh A, Poppas A. Echocardiographic Predictors of Tricuspid Ring Annuloplasty Repair Failure for Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:2624-2633. [DOI: 10.1053/j.jvca.2019.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/20/2023]
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34
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Utsunomiya H, Harada Y, Susawa H, Takahari K, Ueda Y, Izumi K, Itakura K, Ikenaga H, Hidaka T, Fukuda Y, Shiota T, Kihara Y. Comprehensive Evaluation of Tricuspid Regurgitation Location and Severity Using Vena Contracta Analysis: A Color Doppler Three-Dimensional Transesophageal Echocardiographic Study. J Am Soc Echocardiogr 2019; 32:1526-1537.e2. [PMID: 31563434 DOI: 10.1016/j.echo.2019.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical significance of three-dimensional (3D) vena contracta area (VCA) in tricuspid regurgitation (TR) is not fully elucidated. The aim of this study was to investigate the diagnostic accuracy of 3D VCA using 3D echocardiography-derived regurgitation volume as a reference standard. METHODS One hundred sixteen patients with at least moderate TR underwent two-dimensional transthoracic and color Doppler 3D transesophageal echocardiography. The 3D vena contracta, which was located at the narrowest neck of the TR jet just above and toward the right atrial side of the flow convergence zone, was assessed for TR location and severity. RESULTS As for TR location, patients with severe functional TR had the highest prevalence of central jet location among TR subgroups, whereas patients with severe primary TR showed a greater spatial extent of TR jet location involved compared with the moderate TR group (P < .05 for both). As for TR severity, a 3D VCA cutoff value of 0.61 cm2 discriminated severe TR with sensitivity of 78% and specificity of 97% in the total patient population (area under the curve = 0.93, P < .001). Multivariate analysis revealed that 3D VCA, a dilated right ventricle, and hepatic vein systolic reversal were independently associated with regurgitant volume (P < .001 for all). The χ2 value for the model that incorporated clinical and two-dimensional integrative parameters and 3D VCA > 0.61 cm2 to evaluate severe TR was significantly higher than that for the model that incorporated only clinical and two-dimensional integrative parameters (P = .001). CONCLUSIONS Three-dimensional VCA has independent and incremental diagnostic value for evaluating severe TR. Comprehensive evaluation of TR location and severity using 3D vena contracta analysis may help in treatment selection for TR.
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Affiliation(s)
- Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Yu Harada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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35
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Predictors and Outcomes of Persistent Tricuspid Regurgitation After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:772-780. [PMID: 31280838 DOI: 10.1016/j.amjcard.2019.05.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022]
Abstract
Persistent tricuspid regurgitation (TR) after transcatheter aortic valve implantation (TAVI) has been reported to increase mortality. The aim of this study was to investigate clinical and echocardiographic determinants and outcome of persistent TR after TAVI. We reviewed 1,085 patients who underwent TAVI. Among them, 100 patients who had ≥moderate TR without organic dysfunction of the tricuspid valve apparatus were studied. Preprocedural and follow-up transthoracic echocardiography after TAVI were analyzed. After TAVI, patients were divided into persistent TR group and improved TR group. Clinical event was defined as all-cause mortality and readmission for heart failure within 1,000 days. Fifty-three (53%) patients had persistent TR, whereas 47 (47%) patients had improved TR. Risk of clinical event was significantly higher in the persistent TR group compared with the improved TR group. Atrial fibrillation (AF) and tricuspid annular dimension (TAD; p <0.05 for all) were independent predictors of persistent TR. Receiver operating characteristic curve showed the optimal cut-off value of TAD for predicting persistent TR was 37 mm. The combination of AF and TAD ≥37 mm was associated with persistent TR (p <0.001). In conclusion, AF and dilated TAD before TAVI predicted persistent TR which was associated with higher all-cause mortality and readmission for heart failure.
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36
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Wang BY, Li L, Zhou D, Zhang M. Application of three-dimensional proximal isovelocity surface area method in tricuspid regurgitation quantification. Echocardiography 2019; 36:1315-1321. [PMID: 31246345 DOI: 10.1111/echo.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Recently, three-dimensional proximal isovelocity surface area (3D PISA) method has already been widely used in tricuspid regurgitation assessment. This study attempts to demonstrate the feasibility and accuracy of 3D PISA quantifying tricuspid regurgitation and explore the clinical value of 3D PISA in quantifying tricuspid regurgitation. METHODS Fifty-four patients with more than mild tricuspid regurgitation (TR) were enrolled. Effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were assessed by transthoracic 3D PISA method and three-dimensional vena contracta area (3D VCA) method. The 3D VCA was used as reference method. We analyzed the correlation and differences of EROA between 3D PISA method and the reference method. RESULTS Both EROA and Rvol assessed by the 3D PISA had good correlations with the reference method, particularly in the assessment of eccentric jets, with the correlation coefficients of r (EROA) = 0.83, P < 0.001, r (Rvol) = 0.90, P < 0.001, respectively. 3D PISA method had good agreement with 3D VCA method in grading TR. Intra-observer and inter-observer agreement were also good. CONCLUSIONS Three-dimensional proximal isovelocity surface area method can accurately quantify the degree of tricuspid regurgitation with good repeatability and shorter time-consuming, which is worthy of further study. 3D PISA method is expected to be a new method for evaluating tricuspid regurgitation in clinic practice.
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Affiliation(s)
- Bing-Yan Wang
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, China
| | - Lian Li
- Department of Ultrasound, Nanfang Hospital of Nanfang Medical University, Guangdong, China
| | - Dan Zhou
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, China
| | - Ming Zhang
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, China
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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38
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Morphological Assessment of the Tricuspid Apparatus and Grading Regurgitation Severity in Patients With Functional Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:652-664. [DOI: 10.1016/j.jcmg.2018.09.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 01/20/2023]
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39
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Silbiger JJ. Atrial functional tricuspid regurgitation: An underappreciated cause of secondary tricuspid regurgitation. Echocardiography 2019; 36:954-957. [PMID: 30919501 DOI: 10.1111/echo.14327] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022] Open
Abstract
Secondary tricuspid regurgitation (TR) caused by right ventricular enlargement in the setting of left heart disease/pulmonary hypertension has been well described. In contrast, that associated with right atrial enlargement-atrial functional TR (AF-TR)-remains largely underappreciated. AF-TR most often occurs in the setting of lone atrial fibrillation, although it is also seen in its absence (idiopathic AF-TR). Several recent studies have found that the prevalence, hemodynamic significance, and prognosis of AF-TR are not inconsequential, suggesting increased physician awareness of this novel clinical entity is warranted. This article discusses the pathogenesis, echocardiographic findings, and treatment of this underappreciated cause of secondary TR.
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40
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Dahou A, Ong G, Hamid N, Avenatti E, Yao J, Hahn RT. Quantifying Tricuspid Regurgitation Severity. JACC Cardiovasc Imaging 2019; 12:560-562. [DOI: 10.1016/j.jcmg.2018.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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41
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Imaging Assessment of Tricuspid Regurgitation Severity. JACC Cardiovasc Imaging 2019; 12:469-490. [DOI: 10.1016/j.jcmg.2018.07.033] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/30/2023]
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42
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Surkova E, Muraru D, Aruta P, Romeo G, Bidviene J, Cherata D, Badano LP. Current Clinical Applications of Three-Dimensional Echocardiography: When the Technique Makes the Difference. Curr Cardiol Rep 2017; 18:109. [PMID: 27628295 DOI: 10.1007/s11886-016-0787-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Advances in ultrasound, computer, and electronics technology have permitted three-dimensional echocardiography (3DE) to become a clinically viable imaging modality, with significant impact on patient diagnosis, management, and outcome. Thanks to the inception of a fully sampled matrix transducer for transthoracic and transesophageal probes, 3DE now offers much faster and easier data acquisition, immediate display of anatomy, and the possibility of online quantitative analysis of cardiac chambers and heart valves. The clinical use of transthoracic 3DE has been primarily focused, albeit not exclusively, on the assessment of cardiac chamber volumes and function. Transesophageal 3DE has been applied mostly for assessing heart valve anatomy and function. The advantages of using 3DE to measure cardiac chamber volumes derive from the lack of geometric assumptions about their shape and the avoidance of the apical view foreshortening, which are the main shortcomings of volume calculations from two-dimensional echocardiographic views. Moreover, 3DE offers a unique realistic en face display of heart valves, congenital defects, and surrounding structures allowing a better appreciation of the dynamic functional anatomy of cardiac abnormalities in vivo. Offline quantitation of 3DE data sets has made significant contributions to our mechanistic understanding of normal and diseased heart valves, as well as of their alterations induced by surgical or interventional procedures. As reparative cardiac surgery and transcatheter procedures become more and more popular for treating structural heart disease, transesophageal 3DE has expanded its role as the premier technique for procedure planning, intra-procedural guidance, as well as for checking device function and potential complications after the procedure.
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Affiliation(s)
- Elena Surkova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Internal Medicine, Samara State Medical University, Chapaevskaya Str. 89, 443099, Samara, Russian Federation
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
| | - Patrizia Aruta
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Gabriella Romeo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Jurate Bidviene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Diana Cherata
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Hahn RT, Meduri CU, Davidson CJ, Lim S, Nazif TM, Ricciardi MJ, Rajagopal V, Ailawadi G, Vannan MA, Thomas JD, Fowler D, Rich S, Martin R, Ong G, Groothuis A, Kodali S. Early Feasibility Study of a Transcatheter Tricuspid Valve Annuloplasty. J Am Coll Cardiol 2017; 69:1795-1806. [DOI: 10.1016/j.jacc.2017.01.054] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
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44
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Utsunomiya H, Itabashi Y, Mihara H, Kobayashi S, De Robertis MA, Trento A, Shiota T. Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty. Eur Heart J Cardiovasc Imaging 2017; 18:809-817. [DOI: 10.1093/ehjci/jew323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/09/2017] [Indexed: 01/10/2023] Open
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Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel RJ, Shiota T. Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.004897. [DOI: 10.1161/circimaging.116.004897] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 11/07/2016] [Indexed: 01/24/2023]
Abstract
Background—
Functional tricuspid regurgitation (TR) with a structurally normal tricuspid valve (TV) may occur secondary to chronic atrial fibrillation (AF). However, the clinical and echocardiographic differences according to functional TR subtypes are unclear. Therefore, characterization of functional TR because of chronic AF (AF-TR) remains undetermined.
Methods and Results—
To investigate the prevalence of AF-TR, 437 patients with moderate to severe TR underwent 3-dimensional (3D) transesophageal echocardiography. TR severity was determined by the averaged vena contracta width on apical and parasternal inflow views. The prevalence of AF-TR was 9.2%, whereas that of functional TR because of left-sided heart disease was 45.3%. Clinical features of AF-TR included advanced age, female sex, greater right atrial than left atrial enlargement and lower systolic pulmonary artery pressure compared with left-sided heart disease-TR with sinus rhythm (all
P
<0.05). In 3D TV assessment, patients with AF-TR had a larger TV annular area with weaker annular contraction (both
P
<0.001) but a smaller tethering angle (
P
<0.001) despite a similar leaflet coaptation status compared with patients with left-sided heart disease-TR with sinus rhythm. On multivariable analysis, only the TV annular area in midsystole (coefficient, 0.059; 95% confidence interval, 0.041–0.078 per 100 mm
2
;
P
<0.001) was associated with TR severity in AF-TR. The annular area was more closely correlated with the right atrial volume than right ventricular end-systolic volume in AF-TR (
P
<0.001).
Conclusions—
AF-TR is not rare and is associated with advanced age and right atrial enlargement. TV deformations and their association with right heart remodeling differ between AF-TR and left-sided heart disease-TR. Our results suggest that in patients with TR secondary to AF, TV annuloplasty should be effective because this entity has annular dilatation without leaflet deformation.
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Affiliation(s)
- Hiroto Utsunomiya
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Yuji Itabashi
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Hirotsugu Mihara
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Javier Berdejo
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Sayuki Kobayashi
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Robert J. Siegel
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Takahiro Shiota
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
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Muraru D, Surkova E, Badano LP. Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management. Korean Circ J 2016; 46:443-55. [PMID: 27482252 PMCID: PMC4965422 DOI: 10.4070/kcj.2016.46.4.443] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/08/2016] [Indexed: 12/19/2022] Open
Abstract
Current knowledge of functional tricuspid regurgitation (FTR) as a progressive entity, worsening the prognosis of patients irrespective of its aetiology, has led to renewed interest in the pathophysiology and assessment of FTR. For the proper management of FTR, not only its severity, but also the mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and leaflet tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. A better assessment of the anatomy and function of tricuspid apparatus and tricuspid regurgitation severity should help with the appropriate selection of patients who will benefit from either surgical tricuspid valve repair/replacement or a percutaneous procedure, especially among patients who are to undergo or have undergone primary left-sided valvular surgery. In this article, we review the anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR, as well as the various treatment options for FTR, including emerging transcatheter procedures. The limitations affecting the current approach to FTR patients and the unmet clinical needs for their management have also been discussed.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
| | - Elena Surkova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
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Huttin O, Voilliot D, Mandry D, Venner C, Juillière Y, Selton-Suty C. All you need to know about the tricuspid valve: Tricuspid valve imaging and tricuspid regurgitation analysis. Arch Cardiovasc Dis 2016; 109:67-80. [DOI: 10.1016/j.acvd.2015.08.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 11/17/2022]
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48
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Quantification of tricuspid regurgitation using two-dimensional velocity encoding cine: optimal plane and reproducibility. Int J Cardiovasc Imaging 2015. [DOI: 10.1007/s10554-015-0715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Afilalo J, Grapsa J, Nihoyannopoulos P, Beaudoin J, Gibbs JSR, Channick RN, Langleben D, Rudski LG, Hua L, Handschumacher MD, Picard MH, Levine RA. Leaflet area as a determinant of tricuspid regurgitation severity in patients with pulmonary hypertension. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002714. [PMID: 25977303 DOI: 10.1161/circimaging.114.002714] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a risk factor for mortality in pulmonary hypertension (PH). TR severity varies among patients with comparable degrees of PH and right ventricular remodeling. The contribution of leaflet adaptation to the pathophysiology of TR has yet to be examined. We hypothesized that tricuspid leaflet area (TLA) is increased in PH, and that the adequacy of this increase relative to right ventricular remodeling determines TR severity. METHODS AND RESULTS A prospective cohort of 255 patients with PH from pre and postcapillary pathogeneses was assembled from 2 centers. Patients underwent a 3-dimensional echocardiogram focused on the tricuspid apparatus. TLA was measured with the Omni 4D software package. Compared with normal controls, patients with PH had a 2-fold increase in right ventricular volumes, 62% increase in annular area, and 49% increase in TLA. Those with severe TR demonstrated inadequate increase in TLA relative to the closure area, such that the ratio of TLA:closure area <1.78 was highly predictive of severe TR (odds ratio, 68.7; 95% confidence interval, 16.2-292.7). The median vena contracta width was 8.5 mm in the group with small TLA and large closure area as opposed to 4.8 mm in the group with large TLA and large closure area. CONCLUSIONS TLA plays a significant role in determining which patients with PH develop severe functional TR. The ratio of TLA:closure area, reflecting the balance between leaflet adaptation versus annular dilation and tethering forces, is an indicator of TR severity that may identify which patients stand to benefit from leaflet augmentation during tricuspid valve repair.
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Affiliation(s)
- Jonathan Afilalo
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston.
| | - Julia Grapsa
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Petros Nihoyannopoulos
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Jonathan Beaudoin
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - J Simon R Gibbs
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Richard N Channick
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - David Langleben
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Lawrence G Rudski
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Lanqi Hua
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Mark D Handschumacher
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Michael H Picard
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
| | - Robert A Levine
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory, Division of Cardiology (J.A., J.B., L.H., M.D.H., M.H.P., R.A.L.), Massachusetts General Hospital, Harvard University, Boston
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50
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Afilalo J, Grapsa J, Nihoyannopoulos P, Beaudoin J, Gibbs JSR, Channick RN, Langleben D, Rudski LG, Hua L, Handschumacher MD, Picard MH, Levine RA. Leaflet Area as a Determinant of Tricuspid Regurgitation Severity in Patients With Pulmonary Hypertension. Circ Cardiovasc Imaging 2015. [DOI: 10.1161/circimaging.114.002714 e002714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Background—
Tricuspid regurgitation (TR) is a risk factor for mortality in pulmonary hypertension (PH). TR severity varies among patients with comparable degrees of PH and right ventricular remodeling. The contribution of leaflet adaptation to the pathophysiology of TR has yet to be examined. We hypothesized that tricuspid leaflet area (TLA) is increased in PH, and that the adequacy of this increase relative to right ventricular remodeling determines TR severity.
Methods and Results—
A prospective cohort of 255 patients with PH from pre and postcapillary pathogeneses was assembled from 2 centers. Patients underwent a 3-dimensional echocardiogram focused on the tricuspid apparatus. TLA was measured with the Omni 4D software package. Compared with normal controls, patients with PH had a 2-fold increase in right ventricular volumes, 62% increase in annular area, and 49% increase in TLA. Those with severe TR demonstrated inadequate increase in TLA relative to the closure area, such that the ratio of TLA:closure area <1.78 was highly predictive of severe TR (odds ratio, 68.7; 95% confidence interval, 16.2–292.7). The median vena contracta width was 8.5 mm in the group with small TLA and large closure area as opposed to 4.8 mm in the group with large TLA and large closure area.
Conclusions—
TLA plays a significant role in determining which patients with PH develop severe functional TR. The ratio of TLA:closure area, reflecting the balance between leaflet adaptation versus annular dilation and tethering forces, is an indicator of TR severity that may identify which patients stand to benefit from leaflet augmentation during tricuspid valve repair.
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Affiliation(s)
- Jonathan Afilalo
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Julia Grapsa
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Petros Nihoyannopoulos
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Jonathan Beaudoin
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - J. Simon R. Gibbs
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Richard N. Channick
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - David Langleben
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Lawrence G. Rudski
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Lanqi Hua
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Mark D. Handschumacher
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Michael H. Picard
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
| | - Robert A. Levine
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada (J.A., D.L., L.G.R.); Cardiac Ultrasound Laboratory, Division of Cardiology (J.G., P.N.) and National Pulmonary Hypertension Service, Division of Cardiology (J.S.R.G.), Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Pulmonary Hypertension and Thromboendarterectomy Program, Division of Pulmonary and Critical Care Medicine (R.N.C.) and Cardiac Ultrasound Laboratory,
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