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Wang C, Meng L, Cheng XY, Chen YQ. Assessment of right ventricular dysfunction and its association with excess risk of cardiovascular events in patients undergoing maintenance hemodialysis. Ren Fail 2024; 46:2364766. [PMID: 38874087 PMCID: PMC11182060 DOI: 10.1080/0886022x.2024.2364766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
AIMS Recent accumulating evidence has recently documented a significant prevalence of right ventricular dysfunction (RVD) in end-stage renal disease (ESRD) patients. Tricuspid annular plane systolic excursion (TAPSE)/pulmonary-artery systolic pressure (PASP) ratio assessed with echocardiography might be a useful clinical index of right ventricular (RV) -pulmonary arterial (PA) coupling. The current study aimed to investigate the value of the TAPSE/PASP ratios in patients on maintenance hemodialysis (MHD). METHODS We studied 83 times echocardiographic tests from 68 patients with MHD. The associations of TAPSE/PASP ratios with echocardiography variables, clinical characteristics, and biochemical parameters were analyzed, as well as the associations of TAPSE/PASP ratios with odds of all-cause mortality, cardiovascular disease (CVD) events and frequent intermittent dialysis hypotension (IDH). RESULTS Correlation analysis showed TAPSE/PASP ratios positively correlated with LVEF and negatively correlated with E/A and E/e' values. For clinical and biochemical parameters, TAPSE/PASP ratios negatively correlated with BNP, NT-proBNP, age, CRP, and average interdialysis weight gain (ΔBW) and positively correlated with albumin. Logistic regression analysis, which induced the TAPSE/PASP ratio as a continuous variable (per 0.1 mm/mmHg increase), identified that the TAPSE/PASP ratio was associated with decreased CVD events (OR 0.386 [95% CI 0.231-0.645], p < 0.001) and frequent IDH odds (OR 0.571 [95% CI 0.397-0.820], p = 0.002). Moreover, the TAPSE/PASP ratio independently predicted CVD events (adjusted HR 0.539 [95% CI 0.391-0.743], p < 0.001) during a follow-up period of 12 months. CONCLUSIONS RVD, assessed by echocardiography TAPSE/PASP ratio, was found to be associated with increased risks of CVD events and frequent IDH in patients with MHD.
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Affiliation(s)
- Chen Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Li Meng
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Xu-Yang Cheng
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Yu-Qing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
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Dumitriu Carcoana AO, Scoma CB, Maletz SN, Malavet JA, Crousillat DR, Matar FA. Most hospitalized patients with significant tricuspid regurgitation have advanced disease preventing transcatheter tricuspid valve intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:18-24. [PMID: 38503645 DOI: 10.1016/j.carrev.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/04/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND More than moderate tricuspid regurgitation (TR) is associated with high mortality. Surgical tricuspid valve repair and replacements are rarely performed due to high operative mortality risk, mainly attributed to late presentation. Novel transcatheter tricuspid valve intervention (TTVI) devices are being developed as an alternative to surgery. The population of patients presenting to tertiary care centers who can benefit from TTVI has not been well defined. METHODS We retrospectively analyzed 12,677 consecutive 2D echocardiograms completed at our tertiary care center between March 2021 and March 2022 and identified hospitalized patients with more than moderate TR. A total of 569 patients were included in this study. Clinical and echocardiographic data were collected by individual chart review. We used the European Society of Cardiology (ESC) guidelines on the management of valvular disease to retrospectively assign patients to medical, surgical, or transcatheter therapy. RESULTS 458 patients (80.5 %) were assigned to medical therapy, 57 (10.0 %) were assigned to TTVI, and 54 (9.5 %) were assigned to tricuspid valve surgery. Of note, 75.7 % (431/569) of patients were precluded from any intervention due to advanced disease, and only 4.7 % (27/569) presented too early for intervention, being both asymptomatic and without RV dilatation. CONCLUSION Only 10.0 % of patients presenting to a tertiary care center with significant TR would be candidates for TTVI when these technologies are approved in the United States. Earlier identification and treatment of TR could increase the number of patients who may benefit from interventions including TTVI.
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Affiliation(s)
| | | | - Sebastian N Maletz
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jose A Malavet
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Daniela R Crousillat
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA
| | - Fadi A Matar
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA.
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3
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Hahn RT, Lindenfeld J, Böhm M, Edelmann F, Lund LH, Lurz P, Metra M, Tedford RJ, Butler J, Borlaug BA. Tricuspid Regurgitation in Patients With Heart Failure and Preserved Ejection Fraction: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:195-212. [PMID: 38960514 DOI: 10.1016/j.jacc.2024.04.047] [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: 02/07/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality. Important risk factors for the development of HFpEF are similar to risk factors for the progression of tricuspid regurgitation (TR), and both conditions frequently coexist and thus is a distinct phenotype or a marker for advanced HF. Many patients with severe, symptomatic atrial secondary TR have been enrolled in current transcatheter device trials, and may represent patients at an advanced stage of HFpEF. Management of HFpEF thus may affect the pathophysiology of TR, and the physiologic changes that occur following transcatheter treatment of TR, may also impact symptoms and outcomes in patients with HFpEF. This review discusses these issues and suggests possible management strategies for these patients.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, 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
| | - Lars H Lund
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lurz
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | - Marco Metra
- CardiologyCardiology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Anastasiou V, Daios S, Moysidis DV, Liatsos AC, Papazoglou AS, Didagelos M, Savopoulos C, Bax JJ, Ziakas A, Kamperidis V. Right ventricular-pulmonary arterial coupling in patients with first acute myocardial infarction: An emerging post-revascularization triage tool. Hellenic J Cardiol 2024:S1109-9666(24)00139-8. [PMID: 38977061 DOI: 10.1016/j.hjc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 06/09/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) is a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI) that may cause acute RV pressure overload remains unexplored. OBJECTIVES To determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. METHODS Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2±11.8, 24% females). An echocardiogram was performed 24 hours after successful revascularization and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. RESULTS The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in-hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality, after adjustment for Global Registry of Cardiovascular Events (GRACE) risk score and LVEF (Odds Ratio 0.14, 95% Confidence Intervals [0.03-0.56], P-value 0.007). The prognostic value of a baseline model including GRACE risk score and NT-pro-BNP (χ2 26.55) was significantly improved by adding LVEF ≤40 % (χ2 44.71, P-value <0.001), TAPSE ≤17 mm (χ2 75.42, P-value <0.001) and TAPSE/PASP ≤0.49 mm/mmHg (χ2 101.74, P-value <0.001) for predicting cardiovascular in-hospital mortality. CONCLUSIONS RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤0.49 mm/mmHg 24 hours after revascularization, may improve risk stratification for cardiovascular in-hospital mortality post first AMI.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki.
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Alexandros C Liatsos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki
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Nonaka H, Rätsep I, Obonyo NG, Suen JY, Fraser JF, Chan J. Current trends and latest developments in echocardiographic assessment of right ventricular function: load dependency perspective. Front Cardiovasc Med 2024; 11:1365798. [PMID: 39011493 PMCID: PMC11249019 DOI: 10.3389/fcvm.2024.1365798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
Right ventricle (RV) failure is a common complication of many cardiopulmonary diseases. Since it has a significant adverse impact on prognosis, precise determination of RV function is crucial to guide clinical management. However, accurate assessment of RV function remains challenging owing to the difficulties in acquiring its intricate pathophysiology and imaging its complex anatomical structure. In addition, there is historical attention focused exclusively on the left ventricle assessment, which has led to overshadowing and delayed development of RV evaluation. Echocardiography is the first-line and non-invasive bedside clinical tool for assessing RV function. Tricuspid annular plane systolic excursion (TAPSE), RV systolic tissue Doppler velocity of the tricuspid annulus (RV S'), and RV fractional area change (RV FAC) are conventional standard indices routinely used for RV function assessment, but accuracy has been subject to several limitations, such as load-dependency, angle-dependency, and localized regional assessment. Particularly, load dependency is a vexing issue, as the failing RV is always in a complex loading condition, which alters the values of echocardiographic parameters and confuses clinicians. Recently, novel echocardiographic methods for improved RV assessment have been developed. Specifically, "strain", "RV-pulmonary arterial (PA) coupling", and "RV myocardial work" are newly applied methods for RV function assessment, a few of which are designed to surmount the load dependency by taking into account the afterload on RV. In this narrative review, we summarize the latest data on these novel RV echocardiographic parameters and highlight their strengths and limitations. Since load independency is one of the primary advantages of these, we particularly emphasize this aspect.
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Affiliation(s)
- Hideaki Nonaka
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Indrek Rätsep
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
- Clinical Research and Training Department, Initiative to Develop African Research Leaders/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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6
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Crespo-Diaz R, Mudy K, Khan N, Samara M, Eckman PM, Sun B, Hryniewicz K. Right Ventricular Assist Device Placement During Left Ventricular Assist Device Implantation Is Associated With Improved Survival. ASAIO J 2024; 70:570-577. [PMID: 38373178 DOI: 10.1097/mat.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Right ventricular failure (RVF) is a significant cause of mortality in patients undergoing left ventricular assist device (LVAD) implantation. Although right ventricular assist devices (RVADs) can treat RVF in the perioperative LVAD period, liberal employment before RVF is not well established. We therefore compared the survival outcomes between proactive RVAD placement at the time of LVAD implantation with a bailout strategy in patients with RVF. Retrospectively, 75 adult patients who underwent durable LVAD implantation at our institution and had an RVAD placed proactively before LVAD implantation or as a bailout strategy postoperatively due to hemodynamically unstable RVF were evaluated. Patients treated with a proactive RVAD strategy had lower Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and a higher proportion of these required temporary mechanical circulatory support (MCS) preoperatively. Preoperative hemodynamic profiling showed a low pulmonary artery pulsatility index (PAPi) score of 1.8 ± 1.4 and 1.6 ± 0.94 ( p = 0.42) in the bailout RVAD and proactive RVAD groups, respectively. Survival at 3, 6, and 12 months post-LVAD implantation was statistically significantly higher in patients who received a proactive RVAD. Thus, proactive RVAD implantation is associated with short- and medium-term survival benefits compared to a bailout strategy in RVF patients undergoing LVAD placement.
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Affiliation(s)
- Ruben Crespo-Diaz
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Karol Mudy
- Department of Cardiothoracic Surgery, Baptist Health, Little Rock, Arkansas
| | - Nadeem Khan
- Department of Cardiovascular Diseases, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael Samara
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Peter M Eckman
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Benjamin Sun
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Katarzyna Hryniewicz
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Mori R, Gemma D, Casado A, Sliwinsky F, Reyes RM, Palazuelos J. Transcatheter bi-caval valve system: The initial experience. J Cardiol 2024; 84:65-66. [PMID: 38582494 DOI: 10.1016/j.jjcc.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Ricardo Mori
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain.
| | - Daniele Gemma
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Ana Casado
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Frank Sliwinsky
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Roberto Martín Reyes
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Jorge Palazuelos
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
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Mendes LF, Brandão M, Diaz SO, Almeida MC, Barros AS, Saraiva F, Ribeiro J, Rodrigues A, Braga P, Carvalho RF, Sampaio F. Impact of right ventricle-pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03165-0. [PMID: 38940965 DOI: 10.1007/s10554-024-03165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
Right ventricle-pulmonary artery (RV-PA) coupling has been linked to clinical outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter valve implantation (TAVI). However, the best timing for prognostic assessment remains uncertain. Our aim was to determine the impact of RV longitudinal function parameters and RV-PA coupling on mortality in patients undergoing TAVI. Retrospective, single center, analysis including patients with AS who underwent TAVI between 2007 and 2021. Echocardiographic evaluation was performed before, shortly after the procedure, and during follow-up. RV-PA uncoupling was defined as a TAPSE/PASP ratio<0.55 (severe RV uncoupling was defined as TAPSE/PASP ratio<0.32. The effect of RV parameters on all-cause mortality up to 12 months was assessed. Among the 577 patients included, pre-procedural TAPSE/PASP ratio data were available for 205. RV-PA uncoupling was present in 113 patients (55.1%), with severe uncoupling observed in 31 (15.1%). Within the first 12 months after TAVI, 51 patients (9%) died. Severe RV-PA uncoupling was associated with mortality in univariable Cox regression; however, this association was lost after adjusting for EuroSCORE II. A significant association was found between the TAPSE/PASP ratio (per 0.1-unit increase) after the procedure and the primary endpoint (HR: 0.73; 95% CI: 0.56, 0.97; p=0.029). Higher postprocedural PASP (HR: 1.04; 95% CI: 1.02, 1.06; p<0.001 was also associated with all-cause mortality. V-PA uncoupling and PASP after TAVI are associated with all-cause mortality in patients and may be valuable for patient selection and for planning post-procedural care.
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Affiliation(s)
| | - Mariana Brandão
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Silvia O Diaz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - António S Barros
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Ribeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Alberto Rodrigues
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Pedro Braga
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Ricardo Fontes Carvalho
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Sampaio
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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9
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Puri R, Harb SC, Cohen J. Tackling Tricuspid Regurgitation: A "Horses for Courses" and Earlier Approach Is the Future. JACC Cardiovasc Interv 2024; 17:1482-1484. [PMID: 38925752 DOI: 10.1016/j.jcin.2024.05.005] [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: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Cohen
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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10
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Mazzola M, Giannini C, Adamo M, Stolz L, Praz F, Butter C, Pfister R, Iliadis C, Melica B, Sampaio F, Kalbacher D, Koell B, Spieker M, Metra M, Stephan von Bardeleben R, Karam N, Kresoja KP, Lurz P, Petronio AS, Hausleiter J, De Carlo M. Guideline-Directed Medical Therapy and Survival After TEER for Secondary Mitral Regurgitation With Right Ventricular Impairment. JACC Cardiovasc Interv 2024; 17:1455-1466. [PMID: 38925749 DOI: 10.1016/j.jcin.2024.04.025] [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: 10/13/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to guideline-directed medical therapy (GDMT) for heart failure is poor in these patients. OBJECTIVES The aim of this study was to evaluate the impact of GDMT on long-term survival in this patient cohort. METHODS Within the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) international registry, we selected patients with SMR and right ventricular impairment (tricuspid annular plane systolic excursion ≤17 mm and/or echocardiographic right ventricular-to-pulmonary artery coupling <0.40 mm/mm Hg). Titrated guideline-directed medical therapy (GDMTtit) was defined as a coprescription of 3 drug classes with at least one-half of the target dose at the latest follow-up. The primary outcome was all-cause mortality at 6 years. RESULTS Among 1,213 patients with SMR and right ventricular impairment, 852 had complete data on medical therapy. The 123 patients who were on GDMTtit showed a significantly higher long-term survival vs the 729 patients not on GDMTtit (61.8% vs 36.0%; P < 0.00001). Propensity score-matched analysis confirmed a significant association between GDMTtit and higher survival (61.0% vs 43.1%; P = 0.018). GDMTtit was an independent predictor of all-cause mortality (HR: 0.61; 95% CI: 0.39-0.93; P = 0.02 for patients on GDMTtit vs those not on GDMTtit). Its association with better outcomes was confirmed among all subgroups analyzed. CONCLUSIONS In patients with right ventricular impairment undergoing transcatheter edge-to-edge repair for SMR, titration of GDMT to at least one-half of the target dose is associated with a 40% lower risk of all-cause death up to 6 years and should be pursued independent of comorbidities.
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Affiliation(s)
- Matteo Mazzola
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Christian Butter
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Roman Pfister
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center, INSERM (Institut National de la Santé Et de la Recherche Médicale) U970, Paris, France
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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11
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von Stein J, von Stein P, Gietzen T, Althoff J, Hasse C, Metze C, Iliadis C, Gerçek M, Kalbacher D, Kirchner J, Rudolph F, Köll B, Rudolph V, Baldus S, Pfister R, Körber MI. Performance of Transcatheter Direct Annuloplasty in Patients With Atrial and Nonatrial Functional Tricuspid Regurgitation. JACC Cardiovasc Interv 2024; 17:1470-1481. [PMID: 38925751 DOI: 10.1016/j.jcin.2024.04.013] [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: 02/15/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND A novel echocardiography-based definition of atrial functional tricuspid regurgitation (A-FTR) has shown superior outcomes in patients undergoing conservative treatment or tricuspid valve transcatheter edge-to-edge repair. Its prognostic significance for transcatheter tricuspid valve annuloplasty (TTVA) outcomes is unknown. OBJECTIVES This study sought to investigate prognostic, clinical, and technical implications of A-FTR phenotype in patients undergoing TTVA. METHODS This multicenter study investigated clinical and echocardiographic outcomes up to 1 year in 165 consecutive patients who underwent TTVA for A-FTR (characterized by the absence of tricuspid valve tenting, midventricular right ventricular [RV] dilatation, and impaired left ventricular ejection fraction) and nonatrial functional tricuspid regurgitation (NA-FTR). RESULTS A total of 62 A-FTR and 103 NA-FTR patients were identified, with the latter exhibiting more pronounced RV remodeling. Compared to baseline, the tricuspid regurgitation (TR) grade at discharge was significantly reduced (P < 0.001 for both subtypes), and TR ≤II was achieved more frequently in A-FTR (85.2% vs 60.8%; P = 0.001). Baseline TR grade and A-FTR phenotype were independently associated with TR ≤II at discharge and 30 days. In multivariate analyses, A-FTR phenotype was a strong predictor (OR: 5.8; 95% CI: 2.1-16.1; P < 0.001) of TR ≤II at 30 days. At 1 year, functional class had significantly improved compared to baseline (both P < 0.001). One-year mortality was lower in A-FTR (6.5% vs 23.8%; P = 0.011) without significant differences in heart failure hospitalizations (13.3% vs 22.7%; P = 0.188). CONCLUSIONS Direct TTVA effectively reduces TR in both A-FTR, which is a strong and independent predictor of achieving TR ≤II, and NA-FTR. Even though NA-FTR showed more RV remodeling at baseline, both phenotypes experienced similar symptomatic improvement, emphasizing the benefit of TTVA even in advanced disease stages. Additionally, phenotyping was of prognostic relevance in patients undergoing TTVA.
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Affiliation(s)
- Jennifer von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Philipp von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Thorsten Gietzen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Jan Althoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Caroline Hasse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Clemens Metze
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | - Daniel Kalbacher
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Johannes Kirchner
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | - Felix Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | - Benedikt Köll
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Maria Isabel Körber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany.
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12
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Agricola E, Fiore G. Right ventricular function profits from tricuspid regurgitation reduction following tricuspid transcatheter edge-to-edge repair: When is it never too late? Eur J Heart Fail 2024. [PMID: 38837860 DOI: 10.1002/ejhf.3332] [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: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita Salute University San Raffaele, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Culp C, Andrews J, Sun KW, Hunter K, Cherry A, Podgoreanu M, Nicoara A. Right Ventricle-Pulmonary Artery Coupling in Patients Undergoing Cardiac Interventions. Curr Cardiol Rep 2024; 26:521-537. [PMID: 38581563 DOI: 10.1007/s11886-024-02052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac surgery, cardiac interventions, and congenital heart disease. RECENT FINDINGS The need for more accessible clinical means of evaluation of RV-PA coupling has driven researchers to investigate surrogates using cardiac MRI, echocardiography, and right-sided pressure measurements in patients undergoing cardiac surgery/interventions, as well as patients with congenital heart disease. Recent research has aimed to validate these alternative means against the gold standard, as well as establish cut-off values predictive of morbidity and/or mortality. This emerging evidence lays the groundwork for identifying appropriate RV-PA coupling surrogates and integrating them into perioperative clinical practice.
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Affiliation(s)
- Crosby Culp
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA.
| | - Jon Andrews
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Katherine Wang Sun
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado, Aurora, CO, USA
| | - Anne Cherry
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Mihai Podgoreanu
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
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14
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Chen X, Zhang P, Lou J, Zhao R, Zhang S, Xie M, Lv Q. Application of an echocardiographic index to characterize right ventricular-pulmonary arterial coupling in heart failure. ESC Heart Fail 2024; 11:1290-1304. [PMID: 38229524 PMCID: PMC11098638 DOI: 10.1002/ehf2.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Abstract
Heart failure (HF), with its high morbidity and mortality, remains a global public health issue. Right ventricular (RV) dysfunction is a sign of deterioration in the natural history of HF, and a thorough evaluation of the relationship between RV contractility and its afterload through RV-pulmonary arterial (RV-PA) coupling can aid in accurately assessing overall RV function. The ratio of RV end-systolic elastance (Ees) to pulmonary arterial elastance (Ea) invasively measured by right heart catheterization served as the gold standard for evaluating RV-PA coupling. An echocardiographic index termed tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) has been shown to correlate well with Ees/Ea. TAPSE/PASP is recognized as a non-invasive surrogate of RV-PA coupling and has been extensively studied in patients with HF. This review briefly describes the methods of assessing RV-PA coupling, mainly discussing echocardiography, summarizes the clinical utility of TAPSE/PASP in patients with different HF types, and provides an overview of the available literature.
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Affiliation(s)
- Xin Chen
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Peige Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Jie Lou
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Ruohan Zhao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Siyi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
- Shenzhen Huazhong University of Science and Technology Research InstituteShenzhenChina
- Tongji Medical College and Wuhan National Laboratory for OptoelectronicsHuazhong University of Science and TechnologyWuhanChina
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Centre for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
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15
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Vogelhuber J, Tanaka T, Kavsur R, Goto T, Öztürk C, Silaschi M, Nickenig G, Zimmer S, Weber M, Sugiura A. Outcomes of Transcatheter Tricuspid Edge-to-Edge Repair in Patients With Right Ventricular Dysfunction. Circ Cardiovasc Interv 2024; 17:e013156. [PMID: 38629314 DOI: 10.1161/circinterventions.123.013156] [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: 04/16/2023] [Accepted: 03/08/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND We assessed the safety profile of tricuspid transcatheter edge-to-edge repair (TEER) in patients with right ventricular (RV) dysfunction. METHODS We identified patients undergoing TEER to treat tricuspid regurgitation from June 2015 to October 2021 and assessed tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC). RV dysfunction was defined as TAPSE <17 mm and RVFAC <35%. The primary end point was 30-day mortality after TEER. We also investigated the change in the RV function in the early phase and clinical outcomes at 2 years. RESULTS The study participants (n=262) were at high surgical risk (EuroSCORE II, 6.2% [interquartile range, 4.0%-10.3%]). Among them, 44 patients met the criteria of RV dysfunction. Thirty-day mortality was 3.2% in patients with normal RV function and 2.3% in patients with RV dysfunction (P=0.99). Tricuspid regurgitation reduction to ≤2+ was consistently achieved irrespective of RV dysfunction (76.5% versus 70.5%; P=0.44). TAPSE and RVFAC declined after TEER in patients with normal RV function (TAPSE, 19.0±4.7 to 17.9±4.5 mm; P=0.001; RVFAC, 46.2%±8.1% to 40.3%±9.7%; P<0.001). In contrast, those parameters were unchanged or tended to increase in patients with RV dysfunction (TAPSE, 13.2±2.3 to 15.3±4.7 mm; P=0.011; RVFAC, 29.6%±4.1% to 31.6%±8.3%; P=0.14). Two years after TEER, compared with patients with normal RV function, patients with RV dysfunction had significantly higher mortality (27.0% versus 56.3%; P<0.001). CONCLUSIONS TEER was safe and feasible to treat tricuspid regurgitation in patients with RV dysfunction. The decline in the RV function was observed in patients with normal RV function but not in patients with RV dysfunction.
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Affiliation(s)
- Johanna Vogelhuber
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Tetsu Tanaka
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan (T.G.)
| | - Can Öztürk
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery (M.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
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16
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Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A, Bowers MT, Masri SC, Atluri P, Chikwe J, Mason PJ, Kovacic JC, Dangas GD. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1223-e1238. [PMID: 38660790 DOI: 10.1161/cir.0000000000001232] [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] [Indexed: 04/26/2024]
Abstract
Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.
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17
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Lachmann M, Hesse A, Trenkwalder T, Xhepa E, Rheude T, von Scheidt M, Covarrubias HAA, Rippen E, Hramiak O, Pellegrini C, Schuster T, Yuasa S, Schunkert H, Kastrati A, Kupatt C, Laugwitz KL, Joner M. Invasive Assessment of Right Ventricular to Pulmonary Artery Coupling Improves 1-year Mortality Prediction After Transcatheter Aortic Valve Replacement and Anticipates the Persistence of Extra-Aortic Valve Cardiac Damage. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100282. [PMID: 38799808 PMCID: PMC11121747 DOI: 10.1016/j.shj.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 05/29/2024]
Abstract
Background The interplay between the right ventricle and the pulmonary artery, known as right ventricular to pulmonary artery (RV-PA) coupling, is crucial for assessing right ventricular systolic function against the afterload from the pulmonary circulation. Pulmonary artery pressure levels are ideally measured by right heart catheterization. Yet, echocardiography represents the most utilized method for evaluating pulmonary artery pressure levels, albeit with limitations in accuracy. This study therefore aims to evaluate the prognostic significance of right ventricular to pulmonary artery (RV-PA) coupling expressed as tricuspid annular plane systolic excursion (TAPSE) related to systolic pulmonary artery pressure (sPAP) levels measured by right heart catheterization (TAPSE/sPAPinvasive) or estimated by transthoracic echocardiography (TAPSE/sPAPechocardiography) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Methods Using data from a bicentric registry, this study compares TAPSE/sPAPinvasive vs. TAPSE/sPAPechocardiography in predicting 1-year all-cause mortality after TAVR. Results Among 333 patients with complete echocardiography and right heart catheterization data obtained before TAVR, their mean age was 79.8 ± 6.74 years, 39.6% were female, and general 1-year survival was 89.8%. sPAPinvasive and sPAPechocardiography showed only moderate correlation (Pearson correlation coefficient R: 0.53, p value: <0.0001). TAPSE/sPAPinvasive was superior to TAPSE/sPAPechocardiography in predicting 1-year all-cause mortality after TAVR (area under the curve: 0.662 vs. 0.569, p value: 0.025). Patients with reduced TAPSE/sPAPinvasive levels (< 0.365 mm/mmHg) evidenced significantly lower 1-year survival rates than patients with preserved TAPSE/sPAPinvasive levels (81.8 vs. 93.6%, p value: 0.001; hazard ratio for 1-year mortality: 3.09 [95% confidence interval: 1.55-6.17]). Echocardiographic follow-up data revealed that patients with reduced RV-PA coupling suffer from persistent right ventricular dysfunction (TAPSE: 16.6 ± 4.05 mm vs. 21.6 ± 4.81 mm in patients with preserved RV-PA coupling) and severe tricuspid regurgitation (diagnosed in 19.7 vs. 6.58% in patients with preserved RV-PA coupling). Conclusions RV-PA coupling expressed as TAPSE/sPAPinvasive can refine stratification of severe aortic stenosis patients into low-risk and high-risk cohorts for mortality after TAVR. Moreover, it can help to anticipate persistent extra-aortic valve cardiac damage, which will demand further treatment.
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Affiliation(s)
- Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Amelie Hesse
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Teresa Trenkwalder
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Erion Xhepa
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Moritz von Scheidt
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | | | - Elena Rippen
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Oksana Hramiak
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Specialized Department of Cardiology, Ternopil City Communal Hospital №2, Ternopil National Medical University, Ternopil, Ukraine
| | - Costanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Heribert Schunkert
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Adnan Kastrati
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Christian Kupatt
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
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18
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Stąpór M, Sobczyk D, Wasilewski G, Wierzbicki K, Gackowski A, Kleczyński P, Żmudka K, Kapelak B, Legutko J. Right ventricular-pulmonary arterial coupling in patients with implanted left ventricular assist devices. Hellenic J Cardiol 2024; 77:44-53. [PMID: 37295669 DOI: 10.1016/j.hjc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE Both the right ventricular (RV) contractile function and pulmonary arterial (PA) pressure influence clinical outcomes in patients supported with left ventricular assist devices (LVADs), but the impact of RV-PA coupling is unknown. This study aimed to determine the prognostic impact of RV-PA coupling in patients with implanted LVADs. METHODS Patients with implanted third-generation LVADs were retrospectively enrolled. The RV-PA coupling was assessed preoperatively by the ratio of RV free wall strain (RVFWS) derived from speckle-tracking echocardiography and noninvasively measured peak RV systolic pressure (RVSP). The primary end point was a composite of all-cause mortality or right heart failure (RHF) hospitalization. Secondary end points consisted of all-cause mortality at a 12-month follow-up and RHF hospitalization. RESULTS A total of 103 patients were screened, and 72 with good RV myocardial imaging were included. The median age was 57 years; 67 patients (93.1%) were men, and 41 (56,9%) had dilated cardiomyopathy. A receiver-operating characteristic analysis (AUC 0.703, 51.5% sensitivity, 94.9% specificity) was used to identify the optimal cutoff point (0.28%/mmHg) for the RVFWS/TAPSE threshold. Nineteen subjects (26.4%) had advanced RV-PA uncoupling. Event rates were estimated using the Kaplan-Meier method showing a strong association with an increased risk for the primary end point of death or RHF hospitalization (89.47% vs. 30.19%, p < 0.001). A similar observation applied to all-cause mortality (47.37% vs. 13.21%, p = 0.003) and RHF hospitalization (80.43% vs. 20%, p < 0.001). CONCLUSIONS An advanced RV dysfunction assessed by RV-PA coupling may serve as a predictor of adverse outcomes in patients with implanted LVADs.
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Affiliation(s)
- Maciej Stąpór
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Dorota Sobczyk
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Grzegorz Wasilewski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Karol Wierzbicki
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Andrzej Gackowski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Żmudka
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.
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19
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Kadoglou NPE, Khattab E, Velidakis N, Gkougkoudi E, Myrianthefs MM. The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension. J Pers Med 2024; 14:474. [PMID: 38793056 PMCID: PMC11122427 DOI: 10.3390/jpm14050474] [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: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s'), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Elina Khattab
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Nikolaos Velidakis
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Evaggelia Gkougkoudi
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Michael M. Myrianthefs
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
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20
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Fortmeier V, Körber MI, Rommel KP, Stolz L, Kassar M, Praz F, Pfister R, Hausleiter J, Lurz P, Rudolph V. New Diagnostic Criteria for Pulmonary Hypertension: Impact on Survival Prognostication Following Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2024; 17:1073-1075. [PMID: 38658125 DOI: 10.1016/j.jcin.2024.01.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/26/2024]
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21
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Praz F, Beyersdorf F, Haugaa K, Prendergast B. Valvular heart disease: from mechanisms to management. Lancet 2024; 403:1576-1589. [PMID: 38554728 DOI: 10.1016/s0140-6736(23)02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 04/02/2024]
Abstract
Valvular heart disease is common and its prevalence is rapidly increasing worldwide. Effective medical therapies are insufficient and treatment was historically limited to the surgical techniques of valve repair or replacement, resulting in systematic underprovision of care to older patients and those with substantial comorbidities, frailty, or left ventricular dysfunction. Advances in imaging and surgical techniques over the past 20 years have transformed the management of valvular heart disease. Better understanding of the mechanisms and causes of disease and an increasingly extensive and robust evidence base provide a platform for the delivery of individualised treatment by multidisciplinary heart teams working within networks of diagnostic facilities and specialist heart valve centres. In this Series paper, we aim to provide an overview of the current and future management of valvular heart disease and propose treatment approaches based on an understanding of the underlying pathophysiology and the application of multidisciplinary treatment strategies to individual patients.
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Affiliation(s)
- Fabien Praz
- University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Bernard Prendergast
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK
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22
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Ogawa M, Kuwajima K, Yamane T, Hasegawa H, Yagi N, Shiota T. Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033196. [PMID: 38609840 DOI: 10.1161/jaha.123.033196] [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: 10/23/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. METHODS AND RESULTS We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. CONCLUSIONS Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
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Affiliation(s)
- Mana Ogawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Ken Kuwajima
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takafumi Yamane
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Hiroko Hasegawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Nobuichiro Yagi
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takahiro Shiota
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
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23
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Celeski M, Segreti A, Polito D, Valente D, Vicchio L, Di Gioia G, Ussia GP, Incalzi RA, Grigioni F. Traditional and Advanced Echocardiographic Evaluation in Chronic Obstructive Pulmonary Disease: The Forgotten Relation. Am J Cardiol 2024; 217:102-118. [PMID: 38412881 DOI: 10.1016/j.amjcard.2024.02.022] [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: 10/01/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Dajana Polito
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Daniele Valente
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Luisa Vicchio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | | | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
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24
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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [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: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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25
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Adamo M, Russo G, Pagnesi M, Pancaldi E, Alessandrini H, Andreas M, Badano LP, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hahn RT, Harr C, Hausleiter J, Himbert D, Kalbacher D, Ho E, Latib A, Lubos E, Ludwig S, Lupi L, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Marafon DP, Pastorino R, Praz F, Rodes-Cabau J, Besler C, Schöber AR, Schofer J, Scotti A, Piayda K, Sievert H, Tang GHL, Sticchi A, Messika-Zeitoun D, Thiele H, Schlotter F, von Bardeleben RS, Webb J, Dreyfus J, Windecker S, Leon M, Maisano F, Metra M, Taramasso M. Prediction of Mortality and Heart Failure Hospitalization After Transcatheter Tricuspid Valve Interventions: Validation of TRISCORE. JACC Cardiovasc Interv 2024; 17:859-870. [PMID: 38599688 DOI: 10.1016/j.jcin.2024.02.013] [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: 08/07/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Data on the prognostic role of the TRI-SCORE in patients undergoing transcatheter tricuspid valve intervention (TTVI) are limited. OBJECTIVES The aim of this study was to evaluate the performance of the TRI-SCORE in predicting outcomes of patients undergoing TTVI. METHODS TriValve (Transcatheter Tricuspid Valve Therapies) is a large multicenter multinational registry including patients undergoing TTVI. The TRI-SCORE is a risk model recently proposed to predict in-hospital mortality after tricuspid valve surgery. The TriValve population was stratified based on the TRI-SCORE tertiles. The outcomes of interest were all-cause death and all-cause death or heart failure hospitalization. Procedural complications and changes in NYHA functional class were also reported. RESULTS Among the 634 patients included, 223 patients (35.2%) had a TRI-SCORE between 0 and 5, 221 (34.8%) had 6 or 7, and 190 (30%) had ≥8 points. Postprocedural blood transfusion, acute kidney injury, new atrial fibrillation, and in-hospital mortality were more frequent in the highest TRI-SCORE tertile. Postprocedure length of stay increased with a TRI-SCORE increase. A TRI-SCORE ≥8 was associated with an increased risk of 30-day all-cause mortality and all-cause mortality and the composite endpoint assessed at a median follow-up of 186 days (OR: 3.00; 95% CI: 1.38-6.55; HR: 2.17; 95% CI: 1.78-4.13; HR: 2.08, 95% CI: 1.57-2.74, respectively) even after adjustment for procedural success and EuroSCORE II or Society of Thoracic Surgeons Predicted Risk of Mortality. The NYHA functional class improved across all TRI-SCORE values. CONCLUSIONS In the TriValve registry, the TRI-SCORE has a suboptimal performance in predicting clinical outcomes. However, a TRISCORE ≥8 is associated with an increased risk of clinical events and a lack of prognostic benefit after successful TTVI.
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Affiliation(s)
- Marianna Adamo
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paolo Denti
- Division of Cardiology, San Raffaele University Hospital, Milan Italy; Department of Cardiac Surgery, San Raffaele University Hospital, Milan Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Claudia Harr
- Department of Cardiology, Asklepios Clinic Sankt Georg, Hamburg, Germany
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Edwin Ho
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Laura Lupi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland; Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Joachim Schofer
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | | | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Alessandro Sticchi
- Interventional Cardiology, Humanitas Research Hospital, Rozzano Milanese, Italy
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan Italy
| | - Marco Metra
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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26
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Rommel KP, Bonnet G, Fortmeier V, Stolz L, Schöber AR, von Stein J, Kassar M, Gerçek M, Rosch S, Stocker TJ, Körber MI, Kresoja KP, Rudolph TK, Pfister R, Baldus S, Windecker S, Thiele H, Praz F, Hausleiter J, Rudolph V, Burkhoff D, Lurz P. Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry. Eur J Heart Fail 2024; 26:1004-1014. [PMID: 38571456 DOI: 10.1002/ejhf.3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)-related right- heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. METHODS AND RESULTS Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76-83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2-year mortality on Cox regression analyses with Youden index-derived cut-offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre-interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left-sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right-sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right-sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. CONCLUSION In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right-sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre-interventional reduction of right-sided congestion can improve outcomes after TTVI should be established in dedicated studies.
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Affiliation(s)
- Karl-Philipp Rommel
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
- Cardiovacular Research Foundation, New York, NY, USA
| | - Guillaume Bonnet
- Cardiovacular Research Foundation, New York, NY, USA
- University of Bordeaux, Hopital Cardiologique Haut-Lévêque, University Hospital, Bordeaux, France
| | - Vera Fortmeier
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Sebastian Rosch
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Holger Thiele
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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28
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Murphy SP, Deferm S, Yucel E, Urbut SM, Hung J, Dal-Bianco JP, Bertrand PB, Churchill TW. Right Ventricular-Pulmonary Arterial Coupling and All-Cause Mortality in Patients with Mitral Annular Calcification-Related Mitral Valve Dysfunction. J Am Soc Echocardiogr 2024; 37:474-476. [PMID: 38253110 PMCID: PMC11160557 DOI: 10.1016/j.echo.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Seán P Murphy
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114.
| | - Sébastien Deferm
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Sarah M Urbut
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Jacob P Dal-Bianco
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Philippe B Bertrand
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
| | - Timothy W Churchill
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Yawkey 5B, 55 Fruit Street Boston, MA 02114
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Appadurai V, Ayuba G, Flaherty JD, Malaisrie SC, Meng Z, Baldridge AS, Chen C, Slostad B, McCarthy P, Puthumana J, Davidson CJ, Narang A. Temporal Trends in Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Mitral Valve-in-Valve Replacement for Degenerated Mitral Bioprostheses. J Am Soc Echocardiogr 2024; 37:471-473. [PMID: 38237692 DOI: 10.1016/j.echo.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Gloria Ayuba
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - S Christopher Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Zhiying Meng
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Chen Chen
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Jyothy Puthumana
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611.
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30
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Mariani M, Bonanni M, D'Agostino A, Iuliano G, Gimelli A, Coceani MA, Celi S, Sangiorgi GM, Berti S. Multimodality Imaging Approach for Planning and Guiding Direct Transcatheter Tricuspid Valve Annuloplasty. J Am Soc Echocardiogr 2024; 37:449-465. [PMID: 38286242 DOI: 10.1016/j.echo.2024.01.010] [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: 10/06/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
Interest in transcatheter treatment of tricuspid regurgitation (TR) has grown significantly in recent years due to increasing evidence correlating TR severity with mortality and to limited availability of surgical options often considered high-risk in these patients. Although edge-to-edge repair is currently the main transcatheter therapeutic strategy, tricuspid valve direct annuloplasty can also be performed safely and effectively to reduce TR and improve heart failure symptoms and quality of life. In the annuloplasty procedure, an adjustable band is implanted around the tricuspid annulus to reduce valvular size and improve TR. Patient selection and careful preoperative imaging, including transthoracic echocardiography, transesophageal echocardiography, and computed tomography, are critical for procedural success and proper device implantation. Compared to edge-to-edge repair, perioperative imaging with transesophageal echocardiography and fluoroscopy is particularly challenging. Alignment and insertion of the anchors are demanding but essential to achieve good results and avoid damaging the surrounding structures. The presence of shadowing artifacts due to cardiac devices makes the acquisition of good-quality images even more challenging. In this review, we discuss the current role of multimodality imaging in planning direct transcatheter tricuspid valve annuloplasty and describe all procedural steps focusing on echocardiographic monitoring.
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Affiliation(s)
| | - Michela Bonanni
- Adult Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy; Department of Biomedicine and Prevention, Policlinico Tor Vergata, Roma, Italy
| | | | - Giuseppe Iuliano
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Alessia Gimelli
- Department of Cardiac Imaging, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Simona Celi
- BioCardioLab, Bioengineering Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Sergio Berti
- Adult Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
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Tanaka T, Sugiura A, Kavsur R, Öztürk C, Wilde N, Zimmer S, Nickenig G, Weber M, Vogelhuber J. Changes in right ventricular function and clinical outcomes following tricuspid transcatheter edge-to-edge repair. Eur J Heart Fail 2024; 26:1015-1024. [PMID: 38454641 DOI: 10.1002/ejhf.3183] [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: 07/04/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
AIMS Prognostic impact of post-procedural changes in right ventricular (RV) function after tricuspid transcatheter edge-to-edge repair (T-TEER) is still unclear. We investigated association of RV function and its post-procedural changes with clinical outcomes in patients undergoing T-TEER. METHODS AND RESULTS We retrospectively analysed 204 patients who underwent T-TEER and echocardiographic follow-up at 3 months after T-TEER. RV function was assessed by RV fractional area change (RVFAC), and RV dysfunction was defined as RVFAC <35%. Patients with an increase in RVFAC from baseline to the follow-up were considered as RV responders. Patients were divided into four groups according to baseline RVFAC and the RV responder. The primary outcome was a composite of mortality and hospitalization due to heart failure within 1 year. Forty-five of 204 patients (22.1%) had RVFAC <35% at baseline, and 71 (34.8%) were RV responders. The association between the RV responder and the composite outcome had a significant interaction with RVFAC at baseline. Among patients with baseline RVFAC <35%, RV responders had a lower risk of the composite outcome than RV non-responders, while this association was not significant in those with baseline RVFAC ≥35%. Among patients with baseline RVFAC <35%, a smaller RV diameter and a greater reduction of tricuspid regurgitation were predictors for the RV responder. CONCLUSION Post-procedural increase in RVFAC after T-TEER is associated with improved outcomes in patients with RV dysfunction. The factors related to the increase in RVFAC may support patient selection for T-TEER in patients with RV dysfunction.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
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Pieri M, Dormio S, Morosato M, Belletti A, Silvestri D, Montorfano M, Monaco F. Shaping the Anesthetic Approach to TricValve Implantation: Insights From a Case Series. J Cardiothorac Vasc Anesth 2024; 38:911-917. [PMID: 38281824 DOI: 10.1053/j.jvca.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Caval valve implantation (CAVI) represents a minimally invasive strategy for managing severe tricuspid regurgitation in high-risk patients unsuitable for surgical or transcatheter tricuspid valve implantation. This case series aimed to assess the anesthesia management challenges and outcomes associated with this procedure, seeking to generate insights that can inform and refine anesthesia protocols. DESIGN A case series. SETTING At a cardiac catheterization laboratory of a teaching hospital. PARTICIPANTS Eight patients undergoing CAVI with the Tricvalve system INTERVENTIONS: The anesthetic protocol included preprocedural planning, fast-track general anesthesia, and postprocedural debriefing. Intraoperative management involved anesthesia depth monitoring, real-time guidance via transesophageal echocardiography, and hemodynamic stability maintenance. Postoperative analgesia involved preemptive intravenous paracetamol and morphine as needed. MEASUREMENTS AND MAIN RESULTS No anesthesia-related or implantation-related complications were observed, with a mean procedure duration of 112 ± 44 minutes. The median hospital stay was 4 days, and only 1 patient required brief intensive care unit monitoring. Postoperative right shoulder pain was reported by half of the patients, and was managed with morphine bolus administration (average dose 4.75 ± 3.6 mg). All patients had the device correctly positioned, as confirmed by postoperative transthoracic echocardiograms. None of the patients required outpatient analgesic therapy upon discharge. CONCLUSIONS The authors' study demonstrated the potential of TricValve implantation in effectively managing severe tricuspid regurgitation with no procedure-related complications and a 100% survival rate. A collaborative, interdisciplinary approach and targeted anesthesia management proved crucial for this success. Postoperative shoulder pain emerged as a frequent complication, whose pathogenesis is still not clear, and successfully was managed using targeted analgesic therapy.
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Affiliation(s)
- Marina Pieri
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Dormio
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Morosato
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Belletti
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Silvestri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Vita-Salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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33
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Fortmeier V, Lachmann M, Stolz L, von Stein J, Unterhuber M, Kassar M, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Harmsen G, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz KL, Windecker S, Praz F, Lurz P, Hausleiter J, Rudolph V. Artificial intelligence-enabled assessment of right ventricular to pulmonary artery coupling in patients undergoing transcatheter tricuspid valve intervention. Eur Heart J Cardiovasc Imaging 2024; 25:558-572. [PMID: 37996066 DOI: 10.1093/ehjci/jead324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
AIMS Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters. METHODS AND RESULTS This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R: 0.68; P value: 1.3 × 10-8). Moreover, predicted mPAP (mPAPpredicted) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography) levels in predicting 2-year mortality after TTVI [area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10-6]. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10-4). CONCLUSION Artificial intelligence-enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Lukas Stolz
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas J Stocker
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Amelie Hesse
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Gerhard Harmsen
- Department of Physics, University of Johannesburg, Auckland Park, South Africa
| | - Kai Peter Friedrichs
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tanja K Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Michael Joner
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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34
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Muraru D, Badano LP, Hahn RT, Lang RM, Delgado V, Wunderlich NC, Donal E, Taramasso M, Duncan A, Lurz P, De Potter T, Zamorano Gómez JL, Bax JJ, von Bardeleben RS, Enriquez-Sarano M, Maisano F, Praz F, Sitges M. Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment. Eur Heart J 2024; 45:895-911. [PMID: 38441886 PMCID: PMC11095052 DOI: 10.1093/eurheartj/ehae088] [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: 09/11/2023] [Revised: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 03/16/2024] Open
Abstract
Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%-15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, Milan 20126, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, Milan 20149, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, Milan 20126, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, Milan 20149, Italy
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Trias I Pujol, Badalona, Spain
| | | | - Erwan Donal
- CHU Rennes, Inserm, University of Rennes 1, Rennes, France
| | - Maurizio Taramasso
- Department of Cardiac Surgery, HerzZentrum Hirslanden Zürich, Zürich, Switzerland
| | - Alison Duncan
- Heart Division, The Royal Brompton Hospital, London, UK
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
- Department of Cardiology and Heart Valve Center, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstr, Mainz 55131, Germany
| | | | - José L Zamorano Gómez
- Department of Cardiology, University Hospital Ramón y Cajal, Ctra Colmenar Viejo Km 9.1, Madrid, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ralph Stephan von Bardeleben
- Department of Cardiology and Heart Valve Center, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstr, Mainz 55131, Germany
| | | | - Francesco Maisano
- Valve Center IRCCS Ospedale San Raffaele, Cardiac Surgery, University Vita Salute, Milan, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBER, Centro de Investigación Biomédica en Red, Barcelona, Spain
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [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: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Berg-Hansen K, Gopalasingam N, Clemmensen TS, Andersen MJ, Mellemkjaer S, Poulsen SH, Jensen JK, Nielsen R. Myocardial work across different etiologies of right ventricular dysfunction and healthy controls. Int J Cardiovasc Imaging 2024; 40:675-684. [PMID: 38305942 PMCID: PMC10950966 DOI: 10.1007/s10554-023-03038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024]
Abstract
Evaluating right ventricular (RV) function remains a challenge. Recently, novel echocardiographic assessment of RV myocardial work (RVMW) by non-invasive pressure-strain loops was proposed. This enables evaluation of right ventriculoarterial coupling and quantifies RV dyssynchrony and post-systolic shortening. We aimed to assess RVMW in patients with different etiologies of RV dysfunction and healthy controls. We investigated healthy controls (n=17), patients with severe functional tricuspid regurgitation (FTR; n=22), and patients with precapillary pulmonary hypertension (PCPH; n=20). Echocardiography and right heart catheterization were performed to assess 1) RV global constructive work (RVGCW; work needed for systolic myocardial shortening and isovolumic relaxation), 2) RV global wasted work (RVGWW; myocardial shortening following pulmonic valve closure), and 3) RV global work efficiency (RVGWE; describes the relation between RV constructive and wasted work). RVGCW correlated with invasive RV stroke work index (r=0.66, P<0.001) and increased in tandem with higher afterload, i.e., was low in healthy controls (454±73 mmHg%), moderate in patients with FTR (687±203 mmHg%), and highest among patients with PCPH (881±255 mmHg%). RVGWE was lower and RVGWW was higher in patients with FTR (86±8% and 91 mmHg% [53-140]) or PCPH (86±10% and 110 mmHg% [66-159]) as compared with healthy controls (96±3% and 10 mmHg%). RVMW by echocardiography provides a promising index of RV function to discriminate between patients with RV volume or pressure overload. The prognostic value of this measure needs to be settled in future studies.
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Affiliation(s)
- Kristoffer Berg-Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Nigopan Gopalasingam
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Søren Mellemkjaer
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Jesper Khedri Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
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Fam NP, Ong G, Estevez-Loureiro R, Frerker C, Bedogni F, Sanchez-Recalde A, Berti S, Benetis R, Nickenig G, Peterson MD, Maisano F. Transcatheter Tricuspid Valve Replacement With the Cardiovalve System. JACC Cardiovasc Interv 2024; 17:586-588. [PMID: 38340099 DOI: 10.1016/j.jcin.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
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Hagemeyer D, Merdad A, Sierra LV, Ruberti A, Kargoli F, Bouchat M, Boiago M, Moschovitis A, Deva DP, Stolz L, Ong G, Peterson MD, Piazza N, Taramasso M, Dumonteil N, Modine T, Latib A, Praz F, Hausleiter J, Fam NP. Clinical Characteristics and Outcomes of Patients Screened for Transcatheter Tricuspid Valve Replacement: The TriACT Registry. JACC Cardiovasc Interv 2024; 17:552-560. [PMID: 38418058 DOI: 10.1016/j.jcin.2023.12.016] [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: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Transcatheter tricuspid valve replacement (TTVR) abolishes tricuspid regurgitation (TR) and has emerged as a definitive treatment for TR. OBJECTIVES The purpose of this multicenter, observational study was to determine the clinical characteristics and short-term outcomes of patients with TR screened for TTVR. METHODS Patients underwent TTVR screening at 7 centers on a compassionate-use basis. The primary endpoints were NYHA functional class and TR grade at 30-day follow-up. Secondary endpoints included all-cause mortality, heart failure hospitalization, technical success, and reasons for TTVR screening failure. RESULTS A total of 149 patients (median age 79 years [Q1-Q3: 72-84 years], 54% women) underwent TTVR screening. The TTVR screening failure rate was 74%, mainly related to large tricuspid annular diameter. Patients undergoing TTVR (n = 38) had significant functional improvements (NYHA functional class I or II from 21% to 68%; P < 0.001), with TR ≤1+ in 97% at 30-day follow-up (P < 0.001 from baseline). Technical success was achieved in 91%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 8%, heart failure hospitalization 5%, major bleeding 18%, and reintervention 9%. Patients who failed screening for TTVR and subsequently underwent "bailout" transcatheter edge-to-edge repair (n = 26) had favorable outcomes (NYHA functional class I or II from 27% to 58%; P < 0.001), with TR ≤1+ in 43% at 30-day follow-up (P < 0.001 from baseline). CONCLUSIONS This first real-world report of TTVR screening demonstrated a high screening failure rate, mainly related to large tricuspid annular diameter. Patients undergoing TTVR had superior TR reduction and symptom alleviation compared with bailout tricuspid transcatheter edge-to-edge repair, at the cost of greater procedural complications.
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Affiliation(s)
- Daniel Hagemeyer
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anas Merdad
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura Villegas Sierra
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Andrea Ruberti
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Faraj Kargoli
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marine Bouchat
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Mauro Boiago
- Groupe Cardio-Vasculaire lnterventionnel, Cinique Pasteur, Toulouse, France
| | | | - Djeven P Deva
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Geraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark D Peterson
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nicolas Dumonteil
- Groupe Cardio-Vasculaire lnterventionnel, Cinique Pasteur, Toulouse, France
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fabien Praz
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Neil P Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Samim D, Dernektsi C, Brugger N, Reineke D, Praz F. Contemporary Approach to Tricuspid Regurgitation: Knowns, Unknowns, and Future Challenges. Can J Cardiol 2024; 40:185-200. [PMID: 38052301 DOI: 10.1016/j.cjca.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late, and tricuspid valve interventions (surgical or transcatheter) are underutilised, which may lead to irreversible right ventricular damage and increases risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomised controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared with medical treatment.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Chrisoula Dernektsi
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E, Gómez-Otero I, López-López A, Gutiérrez-Feijoo M, Varela-Román A, García-Seara J, Bouzas-Mosquera A, Crespo-Leiro MG. Prognostic value of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in cardiac amyloidosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00036-7. [PMID: 38296161 DOI: 10.1016/j.rec.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/05/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION AND OBJECTIVES The tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/SPAP) ratio is a noninvasive surrogate of right ventricular to pulmonary circulation that has prognostic implications in patients with heart failure (HF) or pulmonary hypertension. Our purpose was to evaluate the prognostic value of the TAPSE/SPAP ratio in patients with cardiac amyloidosis. METHODS We used the database of the AMIGAL study, a prospective, observational registry of patients with cardiac amyloidosis recruited in 7 hospitals of the Autonomous Community of Galicia, Spain, from January 1, 2018 to October 31, 2022. We selected patients whose baseline TAPSE/SPAP ratio was calculated with transthoracic echocardiography. Long-term survival and survival free of HF hospitalization were assessed by means of 5 different multivariable Cox regression models. Median follow-up was 680 days. RESULTS We studied 233 patients with cardiac amyloidosis, among whom 209 (89.7%) had transthyretin type. The baseline TAPSE/SPAP ratio correlated significantly with clinical outcomes. Depending on the multivariable model considered, the adjusted hazard ratios estimated per 0.1mm/mmHg increase of baseline TAPSE/SPAP ratio ranged from 0.76 to 0.84 for all-cause mortality. Similarly, the ratios for all-cause mortality of HF hospitalization ranged from 0.79 to 0.84. The addition of the baseline TAPSE/SPAP ratio to the predictive model of the United Kingdom National Amyloidosis Centre resulted in an increase in Harrell's c-statistic from 0.662 to 0.705 for all-cause mortality and from 0.668 to 0.707 for all-cause mortality or HF hospitalization. CONCLUSIONS Reduced TAPSE/SPAP ratio is an independent adverse prognostic marker in patients with cardiac amyloidosis.
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Affiliation(s)
- Marta Maccallini
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manuel López-Pérez
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ferrol (CHUF), Servicio Galego de Saúde (SERGAS), Ferrol, A Coruña, Spain
| | - Raquel Bilbao-Quesada
- Servicio de Cardiología, Complexo Hospitalario Universitario de Vigo (CHUVI), Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Eva González-Babarro
- Servicio de Cardiología, Complexo Hospitalario Universitario de Pontevedra (CHOP), Servicio Galego de Saúde (SERGAS), Pontevedra, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Andrea López-López
- Servicio de Cardiología, Hospital Universitario Lucus Augusti (HULA), Servicio Galego de Saúde (SERGAS), Lugo, Spain
| | - Mario Gutiérrez-Feijoo
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ourense (CHUOU), Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - Alfonso Varela-Román
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Javier García-Seara
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Bowcock E, Huang S, Yeo R, Walisundara D, Duncan CF, Pathan F, Strange G, Playford D, Orde S. The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy. Ann Intensive Care 2024; 14:10. [PMID: 38228991 DOI: 10.1186/s13613-024-01242-0] [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: 09/13/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. METHODS We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)-1), middle (≥ 5.9-8.02 mm.(m/s)-1), and high (≥ 8.03 mm.(m/s)-1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. RESULTS Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872-0.985], p < 0.05). Kaplan-Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)-1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. CONCLUSION The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making.
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Affiliation(s)
- Emma Bowcock
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
- University of Sydney, Sydney, Australia.
| | - Stephen Huang
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Rachel Yeo
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | | | - Chris F Duncan
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Faraz Pathan
- University of Sydney, Sydney, Australia
- Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - Geoffrey Strange
- University of Sydney, Sydney, Australia
- The University of Notre Dame, Fremantle, Australia
| | | | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, Antohi EL, Badano L, Ben Gal T, Böhm M, Delgado V, Dreyfus J, Faletra FF, Farmakis D, Filippatos G, Grapsa J, Gustafsson F, Hausleiter J, Jaarsma T, Karam N, Lund L, Lurz P, Maisano F, Moura B, Mullens W, Praz F, Sannino A, Savarese G, Tocchetti CG, van Empel VPM, von Bardeleben RS, Yilmaz MB, Zamorano JL, Ponikowski P, Barbato E, Rosano GMC, Metra M. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024; 26:18-33. [PMID: 38131233 DOI: 10.1002/ejhf.3106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tuvia Ben Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Victoria Delgado
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Francesco F Faletra
- Division of Cardiology, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, Kings College London, London, UK
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Jörg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | | | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Lars Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp Lurz
- Division of Cardiology, University Medical Center, Mainz, Germany
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milan, Italy
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), 'Federico II' University, Naples, Italy
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | | | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Li Q, Zhang M. Echocardiography assessment of right ventricular-pulmonary artery coupling: Validation of surrogates and clinical utilities. Int J Cardiol 2024; 394:131358. [PMID: 37704177 DOI: 10.1016/j.ijcard.2023.131358] [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: 06/27/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Right ventricular-pulmonary artery (RV-PA) coupling indicates efficiency of energy transfer from the right ventricle to the pulmonary circulation. The gold standard measurement, end-systolic elastance/arterial elastance ratio (Ees/Ea), is derived from invasive pressure-volume loop, which is technically demanding, expensive and limited in clinical practice. Recent studies have proposed various non-invasive surrogates of Ees/Ea based on echocardiography assessment, of which TAPSE/PASP ratio is an easily-obtained and validated parameter in severe pulmonary hypertension and rapidly applicated in the diagnosis and risk evaluation of various diseases and cardiac intervention. In this review, we summarized principles and validations of echocardiographic surrogates, and their clinical utilities and also limitations. The goal is to systematically review the research advances of echocardiography assessment of RV-PA coupling and help to guide clinical practice.
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Affiliation(s)
- Qimou Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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44
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Agarwal V, Hahn R. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies. Interv Cardiol Clin 2024; 13:81-99. [PMID: 37980069 DOI: 10.1016/j.iccl.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes.
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Affiliation(s)
- Vratika Agarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA.
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA
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45
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Sugiura A, Tanaka T, Kavsur R, Öztürk C, Silaschi M, Goto T, Weber M, Zimmer S, Nickenig G, Vogelhuber J. Refining accuracy of RV-PA coupling in patients undergoing transcatheter tricuspid valve treatment. Clin Res Cardiol 2024; 113:177-186. [PMID: 38010521 PMCID: PMC10808486 DOI: 10.1007/s00392-023-02339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Assessing right ventricular (RV) function is paramount for risk stratification, which remains challenging in patients with tricuspid regurgitation (TR). We assessed RV-pulmonary artery (PA) coupling and its predictability of outcomes after transcatheter tricuspid valve repair (TTVR). METHODS Study participants comprised patients undergoing transcatheter tricuspid valve repair to treat symptomatic TR from June 2015 to July 2021. We calculated an RV-PA coupling ratio using a formula, which is dividing tricuspid annular plane systolic excursion (TAPSE) by echocardiographically estimated (ePASP) or invasively measured PASP (iPASP) at baseline. The primary outcome was all-cause mortality or heart failure rehospitalization within one year. RESULTS The study participants (n = 206) were at high surgical risk (EuroSCORE II: 7.4 ± 4.8%). The primary outcome occurred in 57 patients within one year. The c-statistics for the outcome were 0.565 (95% CI 0.488-0.643) for TAPSE/ePASP and 0.695 (95% CI 0.631-0.759) for TAPSE/iPASP. The correlation between the ePASP and iPASP was attenuated in patients with massive/torrential TR compared to those with severe TR (interaction p = 0.01). In the multivariable Cox proportional model, TAPSE/iPASP was inversely associated with the risk of the primary outcome (per 0.1-point increase: adjusted-HR 0.67, 95% CI 0.56-0.82, p < 0.001), independent of baseline demographics. According to the TAPSE/iPASP quartiles (i.e., ≤ 0.316; 0.317-0.407; 0.408-0.526; ≥ 0.527), the event-free survival was 43.4%, 48.3%, 77.9%, and 85.4% at one year after TTVR. CONCLUSION RV-PA coupling predicts one-year mortality and heart failure rehospitalization after TTVR in patients with TR. The predictability is improved if invasively-measured PA pressure is included.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Kuwajima K, Ogawa M, Ruiz I, Yamane T, Hasegawa H, Yagi N, Rader F, Siegel RJ, Shiota T. Comparison of prognostic value among echocardiographic surrogates of right ventricular-pulmonary arterial coupling: A three-dimensional echocardiographic study. Echocardiography 2024; 41:e15717. [PMID: 37990989 DOI: 10.1111/echo.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Right ventricular (RV)-pulmonary arterial (PA) coupling is important in various cardiac diseases. Recently, several echocardiographic surrogates for RV-PA coupling have been proposed and reported to be useful in predicting outcomes. However, it remains unclear which surrogate is the most clinically relevant. This study aimed to comprehensively compare the prognostic value of different echocardiographic RV-PA coupling surrogates. METHODS We retrospectively reviewed 242 patients with various cardiac conditions who underwent comprehensive transthoracic echocardiography with three-dimensional RV data. In addition to conventional parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and PA systolic pressure (PASP), we analyzed RV free wall and global longitudinal strain (FWLS and GLS). We also obtained RV ejection fraction (RVEF), stroke volume (SV), and end-systolic volume (ESV) using three-dimensional RV analysis. RV-PA coupling surrogates were calculated as TAPSE/PASP, FAC/PASP, FWLS/PASP, GLS/PASP, RVEF/PASP, and SV/ESV. The study endpoint was a composite outcome of all-cause death or cardiovascular hospitalization within 1 year. RESULTS In multivariable analysis, all the RV-PA coupling surrogates were independent predictors of the outcome. Among the surrogates, the model with TAPSE/PASP showed the lowest prognostic value in model fit and discrimination ability, whereas the model with RVEF/PASP exhibited the highest prognostic value. The partial likelihood ratio test indicated that the model with RVEF/PASP was significantly better than the model with TAPSE/PASP (p < .024). CONCLUSION All the RV-PA coupling surrogates were independent predictors of the outcome. Notably, RVEF/PASP had the highest prognostic value among the surrogates.
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Affiliation(s)
- Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irving Ruiz
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nobuichiro Yagi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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47
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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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Kodali S, Hahn RT, Makkar R, Makar M, Davidson CJ, Puthumana JJ, Zahr F, Chadderdon S, Fam N, Ong G, Yadav P, Thourani V, Vannan MA, O'Neill WW, Wang DD, Tchétché D, Dumonteil N, Bonfils L, Lepage L, Smith R, Grayburn PA, Sharma RP, Haeffele C, Babaliaros V, Gleason PT, Elmariah S, Inglessis-Azuaje I, Passeri J, Herrmann HC, Silvestry FE, Lim S, Fowler D, Webb JG, Moss R, Modine T, Lafitte S, Latib A, Ho E, Goldberg Y, Shah P, Nyman C, Rodés-Cabau J, Bédard E, Brugger N, Sannino A, Mack MJ, Leon MB, Windecker S. Transfemoral tricuspid valve replacement and one-year outcomes: the TRISCEND study. Eur Heart J 2023; 44:4862-4873. [PMID: 37930776 DOI: 10.1093/eurheartj/ehad667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND AIMS For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter tricuspid valve (TV) intervention studies have shown significant improvements in functional status and quality of life associated with right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained improvements in these outcomes. METHODS The prospective, single-arm, multicentre TRISCEND study enrolled 176 patients to evaluate the safety and performance of transcatheter TV replacement in patients with ≥moderate, symptomatic TR despite medical therapy. Major adverse events, reduction in TR grade and haemodynamic outcomes by echocardiography, and clinical, functional, and quality-of-life parameters are reported to one year. RESULTS Enrolled patients were 71.0% female, mean age 78.7 years, 88.0% ≥ severe TR, and 75.4% New York Heart Association classes III-IV. Tricuspid regurgitation was reduced to ≤mild in 97.6% (P < .001), with increases in stroke volume (10.5 ± 16.8 mL, P < .001) and cardiac output (0.6 ± 1.2 L/min, P < .001). New York Heart Association class I or II was achieved in 93.3% (P < .001), Kansas City Cardiomyopathy Questionnaire score increased by 25.7 points (P < .001), and six-minute walk distance increased by 56.2 m (P < .001). All-cause mortality was 9.1%, and 10.2% of patients were hospitalized for heart failure. CONCLUSIONS In an elderly, highly comorbid population with ≥moderate TR, patients receiving transfemoral EVOQUE transcatheter TV replacement had sustained TR reduction, significant increases in stroke volume and cardiac output, and high survival and low hospitalization rates with improved clinical, functional, and quality-of-life outcomes to one year. Funded by Edwards Lifesciences, TRISCEND ClinicalTrials.gov number, NCT04221490.
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Affiliation(s)
- Susheel Kodali
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Firas Zahr
- Oregon Health & Science University, Portland, OR, USA
| | | | - Neil Fam
- St. Michael's Hospital, Toronto, ON, Canada
| | | | - Pradeep Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Vinod Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | | | | | | | | | | | | | - Robert Smith
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
| | - Paul A Grayburn
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
- Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, USA
| | | | | | | | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, MA, USA
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | - Dale Fowler
- University of Virginia, Charlottesville, VA, USA
| | | | | | - Thomas Modine
- Hôpital Haut Lévêque, Pessac, France
- Bordeaux University Hospital, Bordeaux, France
| | | | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Edwin Ho
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Ythan Goldberg
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
- Lenox Hill Hospital, New York, NY, USA
| | - Pinak Shah
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Anna Sannino
- Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, USA
| | - Michael J Mack
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
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Doldi PM, Stolz L, Weckbach LT, Hausleiter J. [T-TEER: description of a development process]. Herz 2023; 48:448-455. [PMID: 37831071 DOI: 10.1007/s00059-023-05213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Tricuspid valve regurgitation (TR) is becoming increasingly more clinically important. While considered as an accompanying symptom of left heart pathologies in the past, TR is now seen as an independent and clinically significant condition. TR can lead to volume overload of the right ventricle, resulting in dilatation of the tricuspid valve annulus and worsening of the regurgitation. Undetected or untreated severe TR can lead to recurrent cardiac decompensation with hospitalization, reduced quality of life and death. Previous treatment options were limited to cardiac surgery and associated with high complication and mortality rates, especially in isolated TR. Therefore, many patients are considered inoperable so that the new interventional treatment measures nowadays often represent the only treatment option. Interventional treatment options such as the edge-to-edge procedure (T-TEER) with TriClip™ or the PASCAL™ system are very safe interventions that have already shown promising results, including reduction of TR, improvement in heart failure symptoms and the quality of life. The influence on the mortality and the necessity for hospitalization due to heart failure are currently being investigated in several randomized studies. Patient selection and timing of the intervention are crucial. Cardiovascular imaging plays a decisive role in selecting the appropriate method and timing of the intervention. The prognosis depends on factors, such as the severity of TR, right ventricular dysfunction, and pulmonary arterial hypertension. Overall, interventional TR treatment is a promising advancement in treatment from which many patients can benefit in the future.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland.
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland
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50
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Eur Heart J 2023; 44:4508-4532. [PMID: 37793121 PMCID: PMC10645050 DOI: 10.1093/eurheartj/ehad653] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland
- University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York,USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York,USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York,USA
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York,USA
- University of California-San Diego, San Diego, California, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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