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Palazzuoli A, Dini FL, Agostoni P, Cartocci A, Morrone F, Tricarico L, Correale M, Mercurio V, Nodari S, Severino P, Badagliacca R, Barillà F, Paolillo S, Filardi PP. Right ventricular dysfunction in chronic heart failure: clinical laboratory and echocardiographic characteristics. (the RIVED-CHF registry). J Cardiovasc Med (Hagerstown) 2024; 25:457-465. [PMID: 38652523 DOI: 10.2459/jcm.0000000000001623] [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: 04/25/2024]
Abstract
BACKGROUND Right ventricular dysfunction (RVD) and pulmonary hypertension have been recognized as two important prognostic features in patients with left side heart failure. Current literature does not distinguish between right heart failure (RHF) and RVD, and the two terms are used indiscriminately to describe pulmonary hypertension and RVD as well as clinical sign of RHF. Therefore, the right ventricle (RV) adaptation across the whole spectrum of left ventricular ejection fraction (LVEF) values has been poorly investigated. METHODS This is a multicenter observational prospective study endorsed by the Italian Society of Cardiology aiming to analyze the concordance between the signs and symptoms of RHF and echocardiographic features of RVD. The protocol will assess patients affected by chronic heart failure in stable condition regardless of the LVEF threshold by clinical, laboratory, and detailed echocardiographic study. During the follow-up period, patients will be observed by direct check-up visit and/or virtual visits every 6 months for a mean period of 3 years. All clinical laboratory and echocardiographic data will be recorded in a web platform system accessible for all centers included in the study. RESULTS The main study goals are: to investigate the concordance and discordance between clinical signs of RHF and RVD measured by ultrasonographic examination; to evaluate prognostic impact (in terms of cardiovascular mortality and heart failure hospitalization) of RVD and RHF during a mean follow-up period of 3 years; to investigate the prevalence of different right ventricular maladaptation (isolated right ventricular dilatation, isolated pulmonary hypertension, combined pattern) and the related prognostic impact. CONCLUSIONS With this protocol, we would investigate the three main RVD patterns according to heart failure types and stages; we would clarify different RVD and pulmonary hypertension severity according to the heart failure types. Additionally, by a serial multiparametric analysis of RV, we would provide a better definition of RVD stage and how much is it related with clinical signs of RHF (ClinicalTrials.gov Identifier: NCT06002321).
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Affiliation(s)
| | | | - PierGiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan
| | | | - Francesco Morrone
- UOSA Malattie Cardiovascolari, Le Scotte Hospital University of Siena
| | - Lucia Tricarico
- UO Cardiologia Universitaria -UTIC Policlinico Riuniti, Foggia
| | | | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Savina Nodari
- Cardiology Unit Spedali riuniti di Brescia University of Brescia
| | - Paolo Severino
- Policlinico Umberto I UOC Cardiologia Università La Sapienza
| | | | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
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2
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Yamano M, Yamano T, Matoba S. Right ventricular dilatation: echocardiographic differential diagnosis. J Med Ultrason (2001) 2024; 51:275-282. [PMID: 38228943 DOI: 10.1007/s10396-023-01399-4] [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: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected, there is the possibility of RV volume overload, RV pressure overload, RV myocardial disease, and even nonpathological RV dilatation. With respect to congenital heart disease with RV volume overload, defects or valvular abnormalities can be easily detected with TTE, with the exception of some diseases. Volumetric assessment using three-dimensional echocardiography may be useful in determining the intervention timing in these diseases. When the disease progresses in patients with pulmonary hypertension as a result of RV pressure overload, RV dilatation becomes more prominent than hypertrophy, and RV functional parameters predict the prognosis at this stage of maladaptive remodeling. The differential diagnosis of cardiomyopathy or comparison with nonpathological RV dilatation may be difficult in the setting of RV myocardial disease. The characteristics of RV functional parameters such as two-dimensional speckle tracking may help differentiate RV cardiomyopathy from other conditions. We review the diseases presenting with RV dilatation, their characteristics, and echocardiographic findings and parameters that are significant in assessing their status or intervention timing.
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Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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3
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Ambrosino M, Sangoi M, Monzer N, Irving B, Fiorilli P, Khazan B, Goldberg S. Tricuspid Regurgitation: A Review of Current Interventional Management. J Am Heart Assoc 2024; 13:e032999. [PMID: 38471826 PMCID: PMC11010023 DOI: 10.1161/jaha.123.032999] [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: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Tricuspid regurgitation is a common yet clinically complex problem, traditionally managed with diuretic therapy with no observable mortality benefit. Older studies on surgical intervention observed poor outcomes; however, this clinical reasoning predates current surgical approaches and novel transcatheter technology. The tricuspid apparatus is a complex structure that poses a technical challenge for surgeons and interventional cardiologists. Recent advances in surgical techniques and transcatheter therapy, particularly edge-to-edge repair devices, have demonstrated promising results for safety, reduction in tricuspid regurgitation, and improving quality of life. We review the clinical, imaging, and hemodynamic findings that characterize patients who should be considered for intervention, alongside the rapidly evolving approaches to interventional management.
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Affiliation(s)
| | - Matthew Sangoi
- Pennsylvania HospitalUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Nasser Monzer
- Pennsylvania HospitalUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Brett Irving
- Pennsylvania HospitalUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Paul Fiorilli
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Benjamin Khazan
- Pennsylvania HospitalUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Sheldon Goldberg
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
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4
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Galloo X, Fortuni F, Meucci MC, Butcher SC, Dietz MF, Prihadi EA, Cosyns B, Delgado V, Bax JJ, Ajmone Marsan N. Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation. Heart 2024; 110:448-456. [PMID: 37903557 DOI: 10.1136/heartjnl-2023-323084] [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: 06/07/2023] [Accepted: 09/23/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis. METHODS Consecutive patients, from a single centre, with first diagnosis of severe STR and RASr measure available, were included. Extensive echocardiographic analysis comprised measures of cardiac chamber size and function, assessed also by two-dimensional speckle-tracking strain analysis. Primary outcome was all-cause mortality, analysed from inclusion until death or last follow-up. The association of RASr with the outcome was evaluated by Cox regression analysis and Akaike information criterion. RESULTS A total of 586 patients with severe STR (age 68±13 years; 52% male) were included. Patients presented with mild right ventricular (RV) dilatation (end-diastolic area 13.8±6.5 cm2/m2) and dysfunction (free-wall strain 16.2±7.2%), and with moderate-to-severe RA dilatation (max area 15.0±5.3 cm2/m2); the median value of RASr was 13%. In the overall population, 10-year overall survival was low (40%, 349 deaths), and was significantly lower in patients with lower RASr (defined by the median value): 36% (195 deaths) for RASr ≤13% compared with 45% (154 deaths) for RASr >13% (log-rank p=0.016). With a median follow-up of 6.6 years, RASr was independently associated with all-cause mortality (HR per 5% RASr increase:0.928; 95% CI 0.864 to 0.996; p=0.038), providing additional value over relevant clinical and echocardiographic covariates (including RA size and RV function/size). CONCLUSIONS Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients.
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Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, UZ Brussel, Brussel, Belgium
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Ospedale Nuovo San Giovanni Battista, Foligno, Umbria, Italy
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Ziekenhuisnetwerk Antwerpen, Antwerpen, Belgium
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Heart Center, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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5
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Fernánez Ruiz A, Ruiz Ortiz M, Fernández-Avilés Irache C, Rodríguez Almodóvar AM, Delgado Ortega M, Esteban Martínez F, Resúa Collazo A, Heredia Campos G, Pan Álvarez-Ossorio M, Mesa Rubio D. New severity criteria for tricuspid regurgitation in a broad population of "real life" patients: Prevalence and prognostic impact. Curr Probl Cardiol 2024; 49:102211. [PMID: 37993009 DOI: 10.1016/j.cpcardiol.2023.102211] [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: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
Introduction Our objective was to determine, in "real life" patients, the prevalence of massive and torrential regurgitation among patients diagnosed with severe tricuspid regurgitation (TR), as well as its impact on long-term prognosis. Methods In a single-center retrospective study, all patients with an echocardiographic diagnosis of severe TR attended at a tertiary care hospital of an European country from January 2008 to December 2017 were recruited. Images were analysed off-line to measure the maximum vena contracta (VC) and TR was classified into three groups: severe (VC ≥ 7 mm), massive (VC 14-20 mm), and torrential (VC ≥ 21 mm). The impact of this classification on the combined event of heart failure (HF) admission and all-cause death in follow-up was investigated. Results A total of 614 patients (70 ± 13 years, 72 % women) were included. 81.4 % had severe TR, 15.8 % massive TR, and 2.8 % torrential TR. The 5-year HF-free survival was 42 %, 43 %, and 12 % (p = 0.001), for the different subgroups of severe TR, respectively. After adjusting for baseline characteristics, TR severity was an independent predictor of survival free of the combined end-point: HR 0.91 [95 % CI 0.70-1.18] p = 0.46, for massive TR; and HR 2.5 [95 % CI 1.49-4.21] p = 0.001, for torrential TR considering severe TR as reference. Conclusions The prevalence of massive and torrential TR is not negligible among patients with severe TR in real life. The prognosis is significantly worse for patients with torrential TR measured by the maximum VC.
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Affiliation(s)
- Ana Fernánez Ruiz
- Cardiology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Martín Ruiz Ortiz
- Cardiology Department, University Hospital Reina Sofía, Córdoba, Spain; Maimonides Institute for Biomedical Research of Córdoba, IMIBIC, Córdoba, Spain.
| | | | | | - Mónica Delgado Ortega
- Cardiology Department, University Hospital Reina Sofía, Córdoba, Spain; Maimonides Institute for Biomedical Research of Córdoba, IMIBIC, Córdoba, Spain
| | | | | | | | - Manuel Pan Álvarez-Ossorio
- Cardiology Department, University Hospital Reina Sofía, Córdoba, Spain; Maimonides Institute for Biomedical Research of Córdoba, IMIBIC, Córdoba, Spain
| | - Dolores Mesa Rubio
- Cardiology Department, University Hospital Reina Sofía, Córdoba, Spain; Maimonides Institute for Biomedical Research of Córdoba, IMIBIC, Córdoba, Spain
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6
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Leonardi D, Bursi F, Fanti D, Dotto A, Ciceri L, Springhetti P, Bergamini C, Tafciu E, Maffeis C, Scarsini R, Enriquez-Sarano M, Ribichini FL, Benfari G. Outpatient tricuspid regurgitation in the community: Clinical context and outcome. Int J Cardiol 2024; 396:131443. [PMID: 37844668 DOI: 10.1016/j.ijcard.2023.131443] [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: 06/10/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a geographically defined area and its outcome, in particular overall survival and hospitalization, considering different clinical contexts. METHODS We retrospectively analyzed consecutive outpatients referred between 2006 and 2013 for echocardiography and clinical evaluation. Patients with at least moderate TR were included and five different clinical settings were defined: concomitant significant left-sided valvular heart disease (LVHD-TR), heart failure (HF-TR), previous open-heart valvular surgery (postop-TR), pulmonary hypertension (PHTN-TR) and isolated TR (isolated-TR). Primary endpoint was a composite outcome of all-cause mortality or first hospitalization for HF. RESULTS Of 6797 consecutive patients with a clinical visit and echocardiograms performed in routine practice in a geographically defined community, moderate or severe TR was found in 4.8% of patients (327) . During median follow-up of 6.1 years, TR severity was a determinant of event-free survival. Analyzed for each clinical subset, eight-year event-free survival was 87 ± 7% for postop-TR subgroup, 75 ± 7% for isolated-TR, 67 ± 6% for PHTN-TR, 58 ± 6% for LHVD -TR and 52 ± 11% for HF-TR. CONCLUSION Moderate or more TR is a notable finding in the community and has impact on event-free survival in all clinical settings, with the worst outcomes when associated with relevant left-sided valvular heart disease and HF.
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Affiliation(s)
- Denis Leonardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Diego Fanti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Dotto
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Ciceri
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
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7
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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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8
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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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9
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Ann Thorac Surg 2023; 116:908-932. [PMID: 37804270 DOI: 10.1016/j.athoracsur.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Baim Institute of Clinical Research, Boston, Massachusetts
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York; University of California-San Diego, San Diego, California
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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10
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Fortuni F, Ajmone Marsan N. Refining the Detection of Systemic Congestion in Severe Tricuspid Regurgitation: Echocardiography May Be the Key. J Am Soc Echocardiogr 2023; 36:1178-1180. [PMID: 37737804 DOI: 10.1016/j.echo.2023.09.002] [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: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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11
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. J Am Coll Cardiol 2023; 82:1711-1735. [PMID: 37804294 DOI: 10.1016/j.jacc.2023.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. https://twitter.com/AnnaSannino198
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. https://twitter.com/PDXHeartValveMD
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York, USA; University of California-San Diego, San Diego, California, USA. https://twitter.com/oribenyehuda
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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12
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Margonato D, Ancona F, Cesari A, Ghantous E, Ingallina G, Melillo F, Stella S, Biondi F, Belli M, Montalto C, Manini C, Montorfano M, De Bonis M, Maisano F, Topilsky Y, Agricola E. The long-term clinical course of moderate tricuspid regurgitation. Int J Cardiol 2023; 387:131135. [PMID: 37364718 DOI: 10.1016/j.ijcard.2023.131135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND To evaluate the long-term clinical outcome of a cohort of patients suffering from moderate tricuspid regurgitation (TR), regardless of its etiology. METHODS Clinical and echocardiographic follow-up were assessed in 250 patients diagnosed with moderate TR between January 2016 and July 2020. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and the composite of heart failure (HF) hospitalization plus tricuspid valve (TV) intervention. RESULTS After a median follow-up of 3.6 years, TR progression occurred in 84 patients (34%). At multivariate analyses, atrial fibrillation (AF, OR 1.81, CI 1.01-3.29, p = 0.045) and right ventricular end-diastolic diameter (RVEDD, OR 2.19, CI 1.26-3.78, p = 0.005) were independent predictors of TR progression. The primary endpoint occurred in 59 patients (24%) and was significantly more frequent in the group with TR progression (p = 0.009). At multivariate analyses, chronic kideney disease (OR 2.80, CI 1.30-6.03, p = 0.009), left ventricular ejection fraction (OR 0.97, CI 0.94-0.99, p = 0.041) and TR progression (OR 2.32, CI 1.31-4.12, p = 0.004) were independent predictors of the primary outcome. Moreover, both the secondary endpoints of CV death and HF hospitalization plus TV intervention were more frequent in the TR progression group (p = 0.001 and p < 0.001, respectively). CONCLUSIONS Moderate TR progresses in a significant proportion of patients over a long-term follow-up, leading to a worse prognosis. TR progression is an independent determinant of hard clinical events and AF and RVEDD are associated with TR progression.
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Affiliation(s)
- Davide Margonato
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy.
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Cesari
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Federico Biondi
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Martina Belli
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Claudio Montalto
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Camilla Manini
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
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13
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Barbieri F, Mattig I, Beyhoff N, Thevathasan T, Romero Dorta E, Skurk C, Stangl K, Landmesser U, Kasner M, Dreger H, Reinthaler M. Procedural success of transcatheter annuloplasty in ventricular and atrial functional tricuspid regurgitation. Front Cardiovasc Med 2023; 10:1189920. [PMID: 37608815 PMCID: PMC10440603 DOI: 10.3389/fcvm.2023.1189920] [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: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
Background Transcatheter annuloplasty is meant to target annular dilatation and is therefore mainly applied in functional tricuspid regurgitation (TR). Due to recent recognition of varying disease pathophysiology and differentiation of ventricular and atrial functional TR (VFTR and AFTR), comparative data regarding procedural success for both disease entities are required. Methods In this consecutively enrolled observational cohort study, 65 patients undergoing transcatheter annuloplasty with a Cardioband® device were divided into VFTR (n = 35, 53.8%) and AFTR (n = 30, 46.2%). Procedural success was assessed by comparing changes in annulus dilatation, vena contracta (VC) width, effective regurgitation orifice area (EROA), as well as reduction in TR severity. Results Overall, improvement of TR by at least two grades was achieved in 59 patients (90.8%), and improvement of TR by at least three grades was realised in 32 patients (49.2%). Residual TR of ≤2 was observed in 52 patients (80.0%). No significant differences in annulus diameter reduction [VFTR: 11 mm (9-13) vs. AFTR: 12 mm (9-16), p = 0.210], VC reduction [12 mm (8-14) vs. 12 mm (7-14), p = 0.868], and EROA reduction [0.62 cm2 (0.45-1.10) vs. 0.54 cm2 (0.40-0.70), p = 0.204] were reported. Improvement by at least two grades [27 (90.0%) vs. 32 (91.4%), p = 1.0] and three grades [14 (46.7%) vs. 18 (51.4%), p = 0.805] was similar in VFTR and AFTR, respectively. No significant difference in the accomplishment of TR grade of ≤2 [21 (70.0%) vs. 31 (88.6%), p = 0.118] was noted. Conclusion According to our results from a real-world scenario, transcatheter annuloplasty with the Cardioband® device may be applied in both VFTR and AFTR with evidence of significant procedural TR reduction.
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Affiliation(s)
- Fabian Barbieri
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Isabel Mattig
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Niklas Beyhoff
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Tharusan Thevathasan
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Romero Dorta
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Carsten Skurk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Karl Stangl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Mario Kasner
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Henryk Dreger
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Markus Reinthaler
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany
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14
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Erbano BO, Schio NA, Lopes RD, Bignoto TC, Olandoski M, da Luz RSB, de Carvalho GD, Erbano LHO, Ramos AIDO, Feres F, Faria JR, Baena CP, Siqueira DADA. Tricuspid Regurgitation and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2023; 120:e20220319. [PMID: 37556650 PMCID: PMC10382153 DOI: 10.36660/abc.20220319] [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: 07/01/2022] [Revised: 02/17/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear. OBJECTIVES To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality. METHODS Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%). RESULTS Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92). CONCLUSIONS Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario.
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Affiliation(s)
- Bruna Olandoski Erbano
- Programa de Pós-GraduaçãoInstituto Dante Pazzanese de CardiologiaUniversidade de São PauloSão PauloSPBrasilPrograma de Pós-Graduação do Instituto Dante Pazzanese de Cardiologia associado à Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nicolle Amboni Schio
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Renato Delascio Lopes
- Duke University HospitalDurhamNorth CarolinaEUADuke University Hospital, Durham, North Carolina – EUA
| | - Tiago Costa Bignoto
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Marcia Olandoski
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Raquel Silva Brito da Luz
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Guilherme Dagostin de Carvalho
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | | | - Fausto Feres
- Programa de Pós-GraduaçãoInstituto Dante Pazzanese de CardiologiaUniversidade de São PauloSão PauloSPBrasilPrograma de Pós-Graduação do Instituto Dante Pazzanese de Cardiologia associado à Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Rocha Faria
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Cristina Pellegrino Baena
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
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15
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Galloo X, Dietz MF, Fortuni F, Prihadi EA, Cosyns B, Delgado V, Bax JJ, Ajmone Marsan N. Prognostic implications of atrial vs. ventricular functional tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2023; 24:733-741. [PMID: 36762683 PMCID: PMC10437306 DOI: 10.1093/ehjci/jead016] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
AIMS Atrial functional tricuspid regurgitation (AFTR) has shown distinctive pathophysiological and anatomical differences compared with ventricular functional tricuspid regurgitation (VFTR) with potential implications for interventions. However, little is known about the difference in long-term prognosis between these two FTR-aetiologies, which was investigated in the current study. METHODS AND RESULTS Patients with severe FTR were divided into two aetiologies, based on echocardiography: AFTR and VFTR. VFTR was further subdivided into (i) left-sided cardiac disease; (ii) pulmonary hypertension; and (iii) right ventricular dysfunction. Long-term mortality rates were compared and independent associates of all-cause mortality were investigated.A total of 1037 patients with severe FTR were included, of which 129 patients (23%) were classified as AFTR and compared with 425 patients (78%) classified as VFTR and in sinus rhythm. Of the 425 VFTR patients, 340 patients (61%) had left-sided cardiac disease, 37 patients (7%) had pulmonary hypertension, and 48 patients (9%) had right ventricular dysfunction. Cumulative 10-year survival rates were significantly better for patients with AFTR (78%) compared with VFTR (46%, log-rank P < 0.001). On multivariable Cox regression analysis, VFTR as well as all VFTR subtypes were independently associated with worse overall survival compared with AFTR (HR: 2.292, P < 0.001 for VFTR). CONCLUSION Patients with AFTR had significantly better survival as compared with patients with VFTR, as well as all VFTR subtypes, independently of other clinical and echocardiographic characteristics.
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Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
- Department of Cardiology, San Giovanni Battista Hospital, Via Massimo Arcamone, 06034 Foligno PG, Italy
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
- Heart Institute, Hospital University Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
- Heart Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330RC Leiden, The Netherlands
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16
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Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
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17
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Fortmeier V, Lachmann M, Unterhuber M, Stolz L, Kassar M, Ochs L, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz KL, Praz F, Windecker S, Hausleiter J, Lurz P, Rudolph V. Epiphenomenon or Prognostically Relevant Interventional Target? A Novel Proportionality Framework for Severe Tricuspid Regurgitation. J Am Heart Assoc 2023; 12:e028737. [PMID: 36926925 PMCID: PMC10111550 DOI: 10.1161/jaha.122.028737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background Tricuspid regurgitation (TR) frequently develops in patients with long-standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results In this multicenter study, we included 533 patients undergoing TTVI for moderate-to-severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2-year all-cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm2/mm Hg (defining proportionate TR) featured significantly lower 2-year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P=0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P<2.2×10-16) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0±4.11 versus 17.0±4.64 mm; P=0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350±0.105 cm2 versus 0.770±0.432 cm2; P<2.2×10-16). Importantly, proportionate TR remained a significant predictor for 2-year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; P=0.006). Conclusions The proposed proportionality framework promises to improve future risk stratification and clinical decision-making by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum Bad Oeynhausen Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar Technical University of Munich Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig University of Leipzig Leipzig Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I Klinikum der Universität München, Ludwig Maximilians University of Munich Munich Germany
| | - Mohammad Kassar
- Department of Cardiology Inselspital Bern, Bern University Hospital Bern Switzerland
| | - Laurin Ochs
- Department of Cardiology, Heart Center University of Cologne Cologne Germany
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum 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 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
| | - Kai Peter Friedrichs
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum 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 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
| | - Fabien Praz
- Department of Cardiology Inselspital Bern, Bern University Hospital Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Inselspital Bern, Bern University Hospital Bern Switzerland
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
- Medizinische Klinik und Poliklinik I Klinikum der Universität München, Ludwig Maximilians University of Munich Munich Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig University of Leipzig Leipzig Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum Bad Oeynhausen Germany
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Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications. Diagnostics (Basel) 2023; 13:diagnostics13040692. [PMID: 36832179 PMCID: PMC9955829 DOI: 10.3390/diagnostics13040692] [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: 12/03/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Peak tricuspid regurgitation (TR) velocity and inferior cava vein (ICV) distention are two recognized features of increased pulmonary artery pressure (PASP) and right atrial pressure, respectively. Both parameters are related to pulmonary and systemic congestion and adverse outcomes. However, few data exist about the assessment of PASP and ICV in acute patients affected by heart failure with preserved ejection fraction (HFpEF). Thus, we investigated the relationship existing among clinical and echocardiographic features of congestion, and we analyzed the prognostic impact of PASP and ICV in acute HFpEF patients. METHODS AND RESULTS We analyzed clinical congestion PASP and ICV value in consecutive patients admitted in our ward by echocardiographic examination using peak Doppler velocity tricuspid regurgitation and ICV diameter and collapse for the assessment of PASP and ICV dimension, respectively. A total of 173 HFpEF patients were included in the analysis. The median age was 81 and median left ventricular ejection fraction (LVEF) was 55% [50-57]. Mean values of PASP was 45 mmHg [35-55] and mean ICV was 22 [20-24] mm. Patients with adverse events during follow-up showed significantly higher values of PASP (50 [35-55] vs. 40 [35-48] mmHg, (p = 0.005) and increased values of ICV (24 [22-25] vs. 22 [20-23] mm, p < 0.001). Multivariable analysis showed prognostic power of ICV dilatation (HR 3.22 [1.58-6.55], p = 0.001) and clinical congestion score ≥ 2 (HR 2.35 [1.12-4.93], p = 0.023), but PASP increase did not reach statistical significance (p = 0.874). The combination of PASP > 40 mmHg and ICV > 21 mm was capable of identifying patients with increased events (45% vs. 20%). CONCLUSIONS ICV dilatation provides additional prognostic information with respect to PASP in patients with acute HFpEF. A combined model adding PASP and ICV assessment to clinical evaluation is a useful tool for predicting HF related events.
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19
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Bohbot Y, Tordjman L, Dreyfus J, Le Tourneau T, Lavie-Badie Y, Selton-Suty C, Elegamandji B, L’official G, Fraix A, Aghezzaf S, Turgeon PY, Messika Zeitoun D, Enriquez-Sarano M, Coisne A, Donal E, Tribouilloy C. Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk. Front Cardiovasc Med 2023; 10:1090572. [PMID: 37180795 PMCID: PMC10172668 DOI: 10.3389/fcvm.2023.1090572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes. Materials and methods In this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm2) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality. Results The relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA <60 mm2 vs. ≥60 mm2 (68 ± 3% vs. 64 ± 5%, p = 0.89). A TCG ≥10 mm was associated with lower four-year survival than a TCG <10 mm (53 ± 7% vs. 69 ± 3%, p < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95% CI] = 1.47[1.13-2.21], p = 0.019) and cardiovascular mortality (adjusted HR[95% CI] = 2.12[1.33-3.25], p = 0.001), whereas an EROA ≥60 mm2 was not associated with all-cause or cardiovascular mortality (adjusted HR[95% CI]: 1.16[0.81-1.64], p = 0.416, and adjusted HR[95% CI]: 1.07[0.68-1.68], p = 0.784, respectively). Conclusion The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated significant functional TR.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Léa Tordjman
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | | | | | - Antoine Fraix
- Cardiology Department CIC-EC, CHU Nancy-Brabois, Nancy, France
| | - Samy Aghezzaf
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
| | | | | | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Augustin Coisne
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
- Cardiovascular Research Foundation, New York, NY, United States
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI—UMR 1099, University of Rennes, Rennes, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Correspondence: Christophe Tribouilloy
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20
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Tricuspid Regurgitation in Acute Heart Failure: Predicting Outcome Using Novel Quantitative Echocardiography Techniques. Diagnostics (Basel) 2022; 13:diagnostics13010109. [PMID: 36611401 PMCID: PMC9818460 DOI: 10.3390/diagnostics13010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background: The prognostic impact of tricuspid regurgitation (TR) in acute heart failure (AHF) remains uncertain. Methods: We retrospectively assessed 418 consecutive AHF patients who underwent comprehensive echocardiographic assessment within 24 h of study recruitment. TR was quantitatively assessed with 3 guideline-directed measures: regurgitant volumes (RgVol), effective regurgitant orifice area (ERO) and vena contracta (VC) diameter. Disproportionate TR was assessed by the ratio of the VC diameter to the tricuspid annulus diameter (VC/TA) ≥ 0.24. Results: The prevalence of significant (i.e., >mild) TR differed when various standard assessment parameters were applied to quantification: RgVol 50.3% (173/344), ERO 75.6% (260/344) and VC diameter 94.6% (335/354). None were able to delineate those at excess risk of all-cause 2-year mortality using guideline-directed cut-offs of mild, moderate and severe TR. Using a cut-off of VC/TA ≥ 0.24, we identified that 36.9% (130/352) had “disproportionate” TR. Disproportionate TR was associated with an excess risk of mortality at 2 years compared to proportionate TR; HR 1.48 (95% CI 1.06−2.06 [p = 0.02]) which was not significant on multivariate assessment (p = 0.94). Conclusions: TR was not associated with outcome in AHF using guideline measures. A new assessment of “Disproportionate” TR carries a higher risk than proportionate TR but was not related to outcome based on multivariate analysis. Further research is needed to quantify TR more effectively to identify cut-offs for future guidelines and disproportionate TR may be an important part of Heart Failure 2.0.
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21
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Nishiura N, Kitai T, Okada T, Sano M, Miyawaki N, Kim K, Murai R, Toyota T, Sasaki Y, Ehara N, Kobori A, Kinoshita M, Koyama T, Furukawa Y. Long-Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation. J Am Heart Assoc 2022; 12:e025751. [PMID: 36565178 PMCID: PMC9973603 DOI: 10.1161/jaha.122.025751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long-term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left-sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all-cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow-up period of 26.5 (interquartile range, 6.0-57.9) months. The 5-year event-free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01-1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002-1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36-0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m2) revealed a graded increase in the risk of adverse events (P<0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.
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Affiliation(s)
- Naoki Nishiura
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan,Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Taiji Okada
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Madoka Sano
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Norihisa Miyawaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Kitae Kim
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Ryosuke Murai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Toshiaki Toyota
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Yasuhiro Sasaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Natsuhiko Ehara
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Atsushi Kobori
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Makoto Kinoshita
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Tadaaki Koyama
- Department of Cardiothoracic SurgeryKobe City Medical Center General HospitalKobeJapan
| | - Yutaka Furukawa
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
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22
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Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients. J Clin Med 2022; 11:jcm11237145. [PMID: 36498719 PMCID: PMC9739196 DOI: 10.3390/jcm11237145] [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: 10/15/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Aim: Atrial fibrillation (AF) is an epidemic disease with a significant global health impact. Atrial functional tricuspid regurgitation (AF-TR) is a more recently acknowledged complication of AF. The main purpose of this study was to determine the prognostic value of severe AF-TR in patients with AF, and its determinants. Methods: In this retrospective, observational study, we included AF patients admitted consecutively to a tertiary clinical hospital between January 2018 and February 2020, irrespective of cause of hospitalization. Patients with organic TR, significant pulmonary hypertension, left ventricular ejection fraction < 50%, those with implanted cardiac devices and those with in-hospital mortality were excluded. Severe TR was defined according to current guidelines. Median follow-up time was 34 (28−39) months. Primary endpoint was all-cause mortality. Results: We included 246 AF patients, with a mean age of 71.5 ± 9.4 years. 86.2% had AF-TR, while 8.1% had severe AF-TR. Mortality rate was 8.5%. Right atrial diameter (p = 0.005), systolic pulmonary artery pressure (sPAP) (p = 0.015) and NT-proBNP (p = 0.026) were independent predictors for the presence of severe valvular dysfunction. In multivariable survival analysis, severe AF-TR, was an independent predictor of all-cause mortality (HR 5.4, 95% CI 1.1−26.2, p = 0.035). Conclusion: Severe AF-TR was an independent predictor of mortality in AF patients, while mild/moderate AF-TR apparently had no impact on prognosis.
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23
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Gheorghe LL, Hegeman R, Vrijkorte M, Wunderlich N, Cavalcante J, Wang DD, Rana B, Vannan M, Timmers L, Swaans M. The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions. Front Cardiovasc Med 2022; 9:793267. [DOI: 10.3389/fcvm.2022.793267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Tricuspid valve pathophysiology is not well-understood. Emergence of novel transcatheter tricuspid therapies has fueled the requirements for improved imaging visualization techniques and interventional imaging physician skillsets in guiding these complex transcatheter procedures. There is growing understanding on the clinical significance of tricuspid regurgitation which expanded the interest for percutaneous tricuspid valve interventions. The present review concentrates on three essential aspects of tricuspid valve pathophysiology: anatomical considerations for tricuspid interventions, optimal timing of tricuspid interventions by imaging guidance, and the role of interventional imaging physicians’ skillset and knowledge in this field.
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24
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Ghio S, Bossone E, Mercurio V, Rudski L, Vannan M. Echocardiographic assessment and clinical implication of functional tricuspid regurgitation in heart failure with reduced or preserved ejection fraction (ECLIPSE-HF). Int J Cardiovasc Imaging 2022; 38:2581-2591. [DOI: 10.1007/s10554-022-02599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/10/2022] [Indexed: 11/05/2022]
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25
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Guo S, Zhang B, Ye Y, Li Z, Liu Q, Zhao Z, Wang W, Yu Z, Zhang H, Zhao Q, Duan Z, Lv J, Zhang E, Wang B, Zhao Y, Gao R, Xu H, Wu Y. Prognostic value of blood pressure and resting heart rate in patients with tricuspid regurgitation. Front Cardiovasc Med 2022; 9:937412. [PMID: 35990948 PMCID: PMC9385404 DOI: 10.3389/fcvm.2022.937412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background The prognostic value of blood pressure (BP) and resting heart rate (RHR) in tricuspid regurgitation (TR) patients is unknown. Aims This study aimed to investigate the associations of BP and RHR with all-cause mortality in patients with TR. Methods A total of 2,013 patients with moderate or severe TR underwent echocardiography and BP measurement. The associations of routinely measured BP and RHR with 2-year all-cause mortality were analyzed. Results The cohort had 45.9% male patients and a mean age of 62.5 ± 15.9 years. At the 2-year follow-up, 165 patient deaths had occurred. The risk of death decreased rapidly, negatively correlating with systolic blood pressure (SBP) up to 120 mmHg and diastolic blood pressure (DBP) up to 70 mmHg. For RHR, the risk increased in direct proportion, starting at 80 beats per min. After adjusting for age, sex, body mass index (BMI), diabetes, coronary heart disease, pulmonary hypertension, estimated glomerular filtration rate (eGFR), and NYHA class, SBP [hazard ratio (HR):0.89; 95% CI:0.823–0.957 per 10 mmHg increase; P =0.002], DBP (HR:0.8; 95% CI:0.714–0.908 per 10 mmHg increase; P < 0.001), and RHR (HR: 1.1; 95% CI: 1.022–1.175 per 10 beats per min increase; P = 0.011) were independently associated with all-cause mortality. These associations persisted after further adjustments for echocardiographic indices, medications, serological tests, and etiologies. Conclusion In this cohort of patients with TR, routinely measured BP and RHR were associated with all-cause mortality independently. However, further large-scale, high-quality studies are required to validate our findings.
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Affiliation(s)
- Shuai Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingrong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiwei Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zikai Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitong Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenya Duan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junxing Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Erli Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bincheng Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yongjian Wu
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Haiyan Xu
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Marwick TH, Chandrashekhar Y. Quantification and Selective Use of Multimodality Imaging in the Assessment of Valvular Regurgitation. JACC Cardiovasc Imaging 2022; 15:957-959. [PMID: 35512965 DOI: 10.1016/j.jcmg.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Maus TM, Cronin B. Tricuspid Regurgitation: The Art within the Science. J Cardiothorac Vasc Anesth 2022; 36:3509-3510. [DOI: 10.1053/j.jvca.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/11/2022]
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28
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Khoche S, Choi C, Kothari P, Hamm K, Poorsattar SP, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights from 2021. J Cardiothorac Vasc Anesth 2022; 36:3459-3468. [DOI: 10.1053/j.jvca.2022.04.002] [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: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/11/2022]
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29
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Lancellotti P, Pibarot P, Chambers J, La Canna G, Pepi M, Dulgheru R, Dweck M, Delgado V, Garbi M, Vannan MA, Montaigne D, Badano L, Maurovich-Horvat P, Pontone G, Vahanian A, Donal E, Cosyns B. Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. Eur Heart J Cardiovasc Imaging 2022; 23:e171-e232. [PMID: 35292799 DOI: 10.1093/ehjci/jeab253] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023] Open
Abstract
Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Imaging is pivotal in the evaluation of native valve regurgitation and echocardiography is the primary imaging modality for this purpose. The imaging assessment of valvular regurgitation should integrate quantification of the regurgitation, assessment of the valve anatomy and function, and the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation largely relies on the results of imaging. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing native valve regurgitation. The present document aims to present clinical guidance for the multi-modality imaging assessment of native valvular regurgitation.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, Valvular Disease Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, 4000 Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy.,Anthea Hospital, Via Camillo Rosalba, 35, Bari, Italy
| | - Philippe Pibarot
- Department of Medicine, Québec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Québec, Canada
| | - John Chambers
- Emeritus Professor of Clinical Cardiology, Guy's and St Thomas' Hospital, London SE1 7EH, UK
| | - Giovanni La Canna
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Hospital, Applied Diagnostic Echocardiography, 20089 Rozzano, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Raluca Dulgheru
- Department of Cardiology, Valvular Disease Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, 4000 Liège, Belgium
| | - Mark Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC Leiden, The Netherlands
| | - Madalina Garbi
- Royal Papworth Hospital, Cambridge University Health Partner, Cambridge Biomedical Campus, CB2 0AY Cambridge, UK
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - David Montaigne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, F-59000 Lille, France
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, 20089 Milan, Italy.,Department of Cardiac, Metabolic and Neural Sciences, Istituto Auxologico Italiano, IRCCS, 20089 Milan, Italy
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, 1083 Budapest, Hungary
| | | | - Alec Vahanian
- UFR Medecine, Université de Paris, Site Bichat, 16 rue Huchard, 75018 Paris, France.,LVTS INSERM U1148, GH Bichat, 46, rue Henri Huchard, 75018 Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
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Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore. J Clin Med 2022; 11:jcm11020382. [PMID: 35054074 PMCID: PMC8781398 DOI: 10.3390/jcm11020382] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the "classical", ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.
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31
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:913-929. [DOI: 10.1093/ehjci/jeac009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
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32
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:989-1000. [DOI: 10.1093/ehjci/jeac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/08/2022] [Indexed: 11/13/2022] Open
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Bucciarelli-Ducci C, Ajmone-Marsan N, Di Carli M, Nicol E. OUP accepted manuscript. Eur Heart J 2022; 43:1288-1295. [PMID: 35259251 PMCID: PMC8970999 DOI: 10.1093/eurheartj/ehac033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/02/2022] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
This article reviews the most relevant literature published in 2021 on the role of cardiovascular imaging in cardiovascular medicine. Coronavirus disease 2019 (COVID-19) continued to impact the healthcare landscape, resulting in reduced access to hospital-based cardiovascular care including reduced routine diagnostic cardiovascular testing. However, imaging has also facilitated the understanding of the presence and extent of myocardial damage caused by the coronavirus infection. What has dominated the imaging literature beyond the pandemic are novel data on valvular heart disease, the increasing use of artificial intelligence (AI) applied to imaging, and the use of advanced imaging modalities in both ischaemic heart disease and cardiac amyloidosis.
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Affiliation(s)
- Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust and School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Corresponding author.
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marcelo Di Carli
- Cardiovascular Imaging Program, Department of Radiology, Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Program, Department of Medicine, Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward Nicol
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust and School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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34
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Praz F, Muraru D, Kreidel F, Lurz P, Hahn RT, Delgado V, Senni M, von Bardeleben R, Nickenig G, Hausleiter J, Mangieri A, Zamorano J, Prendergast BD, Maisano F. Transcatheter treatment for tricuspid valve disease. EUROINTERVENTION 2021; 17:791-808. [PMID: 34796878 PMCID: PMC9724890 DOI: 10.4244/eij-d-21-00695] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
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Affiliation(s)
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Istituto Auxologico Italiano, IRCCS, Department of Cardiological, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | | | | | | | | | | | | | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Department of Cardiology, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Antonio Mangieri
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Jose Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Bernard D. Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic, London, United Kingdom
| | - Francesco Maisano
- Department of Cardiothoracic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
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Bocchino PP, Angelini F, Vairo A, Andreis A, Fortuni F, Franchin L, Frea S, Raineri C, Pidello S, Conrotto F, Montefusco A, Alunni G, De Ferrari GM. Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair: A Meta-Analysis and Meta-Regression Study. JACC Cardiovasc Interv 2021; 14:2285-2295. [PMID: 34674867 DOI: 10.1016/j.jcin.2021.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (moderate or greater) tricuspid regurgitation (TR). BACKGROUND Significant TR is a common valvular heart disease worldwide. METHODS Published research was systematically searched for studies evaluating the efficacy and safety of ITTVR for significant TR in adults. The primary outcomes were improvement in New York Heart Association (NYHA) functional class and 6-minute walking distance and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR. RESULTS Fourteen studies with 771 patients were included. The mean age was 77 ± 8 years, and the mean European System for Cardiac Operative Risk Evaluation II score was 6.8% ± 5.4%. At a weighted mean follow-up of 212 days, 209 patients (35%) were in NYHA functional class III or IV compared with 586 patients (84%) at baseline (risk ratio: 0.23; 95% CI: 0.13-0.40; P < 0.001). Six-minute walking distance significantly improved from 237 ± 113 m to 294 ± 105 m (mean difference +50 m; 95% CI: +34 to +66 m; P < 0.001). One hundred forty-seven patients (24%) showed severe or greater TR after ITTVR compared with 616 (96%) at baseline (risk ratio: 0.29; 95% CI: 0.20-0.42; P < 0.001). CONCLUSIONS Patients undergoing ITTVR for significant TR experienced significant improvements in NYHA functional status and 6-minute walking distance and a significant reduction in TR severity at mid-term follow-up.
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Affiliation(s)
- Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Alessandro Vairo
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Federico Fortuni
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Luca Franchin
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Claudia Raineri
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Stefano Pidello
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Gianluca Alunni
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
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36
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Chevalier B, Neylon A. Isolated Transcatheter Tricuspid Repair for Functional Regurgitation: Are We Selecting the Right Patients? JACC Cardiovasc Interv 2021; 14:2296-2297. [PMID: 34674868 DOI: 10.1016/j.jcin.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
| | - Antoinette Neylon
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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37
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Hahn RT. Predicting Outcomes for Isolated Tricuspid Regurgitation: Multimodality Imaging and Clinical Assessment. Circ Cardiovasc Imaging 2021; 14:e013349. [PMID: 34521211 DOI: 10.1161/circimaging.121.013349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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38
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Wang TKM, Akyuz K, Reyaldeen R, Griffin BP, Popovic ZB, Pettersson GB, Gillinov AM, Flamm SD, Xu B, Desai MY. Prognostic Value of Complementary Echocardiography and Magnetic Resonance Imaging Quantitative Evaluation for Isolated Tricuspid Regurgitation. Circ Cardiovasc Imaging 2021; 14:e012211. [PMID: 34521215 DOI: 10.1161/circimaging.120.012211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Isolated tricuspid regurgitation (TR) remains a management dilemma with poor outcomes. Echocardiography and cardiac magnetic resonance imaging (CMR) are valuable tools for evaluating TR, but their prognostic utility has rarely been studied together in this setting. We aimed to determine the prognostic value and thresholds for echocardiography and CMR parameters for isolated severe TR. METHODS Consecutive patients with isolated severe TR by echocardiography and undergoing CMR during January 2007 to June 2019 were studied. Echocardiography and CMR-derived quantitative parameters were analyzed for independent associations with and thresholds for predicting the primary end point of all-cause mortality during follow-up. RESULTS Among 262 patients studied, mean age was 62.8±15.6 years, 156 (59.5%) were females, 207 (79.0%) had secondary TR, and 87 (33.2%) underwent tricuspid valve surgery after CMR. There were 68 (26.0%) deaths during a mean follow-up of 2.5 years. Both CMR-derived tricuspid regurgitant fraction (per 5% increase) and right ventricle free wall longitudinal strain (per 1% decrease in magnitude) were independently associated with worse survival, with hazard ratios (95% CIs) of 1.15 (1.05-1.25) and 1.10 (1.04-1.17), respectively, along with right heart failure symptoms of 2.03 (1.14-3.60), while tricuspid valve surgery was borderline protective with 0.55 (0.31-0.997). Regurgitant fraction ≥30%, regurgitant volume ≥35 mL and right ventricle free wall longitudinal strain ≥-11% (by velocity vector imaging technique, which yields lower magnitude values than other conventional strain techniques) were the optimal thresholds for mortality during follow-up. CONCLUSIONS TR quantification by CMR and right ventricle free wall longitudinal strain by echocardiography were the key imaging parameters independently associated with reduced survival in isolated TR, incremental to conventional clinical factors. Clinically significant thresholds for these parameters were determined and may help guide decision-making for TR management.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Kevser Akyuz
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popovic
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery (G.B.P., A.M.G.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery (G.B.P., A.M.G.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Scott D Flamm
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bo Xu
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Bannehr M, Kücken T, Ulrike K, Haase-Fielitz A, Butter C. Prognostic Implications of a Novel Algorithm to Grade Secondary Tricuspid Regurgitation. J Am Soc Echocardiogr 2021; 34:1316-1317. [PMID: 34461248 DOI: 10.1016/j.echo.2021.08.014] [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: 03/26/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Marwin Bannehr
- Department of Cardiology, Heart Centre Brandenburg Bernau, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Tanja Kücken
- Department of Cardiology, Heart Centre Brandenburg Bernau, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Kahn Ulrike
- Department of Cardiology, Heart Centre Brandenburg Bernau, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Centre Brandenburg Bernau, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Department of Cardiology, Heart Centre Brandenburg Bernau, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
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Flachskampf FA, Chandrashekhar Y. Beyond the Outer Edge-Are There 1, 3, 4, or 5 Grades of Tricuspid Regurgitation? JACC Cardiovasc Imaging 2021; 14:1293-1295. [PMID: 34112383 DOI: 10.1016/j.jcmg.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Badano LP, Muraru D. Categorical Grading of the Severity of Tricuspid Regurgitation and its Association to Patients' Outcome. JACC Cardiovasc Imaging 2021; 14:1096-1098. [PMID: 34112379 DOI: 10.1016/j.jcmg.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Department of Cardiological, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Department of Cardiological, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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Fortuni F, Hirasawa K, Bax JJ, Delgado V, Ajmone Marsan N. Multi-Modality Imaging for Interventions in Tricuspid Valve Disease. Front Cardiovasc Med 2021; 8:638487. [PMID: 33634175 PMCID: PMC7900427 DOI: 10.3389/fcvm.2021.638487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Several studies have demonstrated that severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Nowadays, several therapeutic options to treat TR are available and patients at high surgical risk can also be treated with transcatheter procedures. For the management of patients with TR, an accurate assessment of the tricuspid valve and its surrounding structures is therefore of crucial importance and has gained significant interest in the medical community. Different imaging modalities can provide detailed information on the tricuspid valve apparatus, right ventricle, right atrium, and coronary circulation which are fundamental to define the timing and anatomic suitability of surgical and percutaneous procedures. The present review illustrates the role of 2D and 3D echocardiography, cardiac magnetic resonance, and multidetector row computed tomography for the assessment of the tricuspid valve and right heart with a particular focus on the data needed for planning and guiding interventional procedures.
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Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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