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Karwiky G, Kamarullah W, Pranata R, Achmad C, Iqbal M. A meta-analysis of the distance between lead-implanted site and tricuspid valve annulus with postoperative tricuspid regurgitation deterioration in patients with left bundle branch area pacing. J Cardiovasc Electrophysiol 2024. [PMID: 39327904 DOI: 10.1111/jce.16444] [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] [Received: 06/19/2024] [Revised: 09/07/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
Tricuspid regurgitation (TR) is a known complication of cardiac implantable electrical devices (CIEDs), with prevalences ranging from 10% to as high as 30%. Despite left bundle branch area pacing (LBBAP) has emerged as an alternative to the limits of His-bundle pacing (HBP), the long-term safety of this procedure, notably the worsening of TR after implantation, has yet to be thoroughly investigated. This meta-analysis sought to determine the frequency of post-LBBAP TR deterioration and identify the predictors, particularly the distance between lead-implanted site and the tricuspid valve annulus (lead-TA-distance). A systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that reported the incidence of deterioration and measurement of TR grade at baseline and follow-up following LBBAP, in addition to the differences in exposure between short and long lead-TA-distances. A total of three studies involving 480 participants were included in this meta-analysis. The incidence of TR deterioration was 22%. Patients with TR deterioration also demonstrated a significantly shorter lead-TA-distance in comparison to the opposing group (MD: -5.74 mm (-0.70, -10.78); p < .001; I2 = 92.6%). The pooled results of three comparative studies suggest that participants in the longer lead-TA-distance group had a significant decrement in the likelihood of TR worsening (adjusted OR = 0.59 (0.36-0.96); p = .034; I2 = 79%). Multivariate analysis conducted in each of the included investigations supported the independence of the connection between lead-TA-distance and TR deterioration. A shorter lead-TA-distance was an independent risk factor for TR deterioration in individuals with post-LBBAP implantation.
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Affiliation(s)
- Giky Karwiky
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - William Kamarullah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Cha MJ, Lee SA, Cho MS, Nam GB, Choi KJ, Kim J. Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation. Heart 2024; 110:523-530. [PMID: 37879881 DOI: 10.1136/heartjnl-2023-323244] [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] [Received: 07/20/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity. METHODS A total of 106 patients with drug-refractory AF with moderate to severe secondary TR who underwent AF ablation were screened from a single-centre ablation registry. Echocardiographic parameter changes (pre-procedure vs 1 day/1 year post-procedure) were analysed. Holter monitoring was performed at 3/6/12 months to assess AF recurrence. The primary outcome was at least one grade TR reduction with its main determinants evaluated. RESULTS After excluding 36 patients (prior tricuspid valve surgery, intracardiac devices or insufficient data), 70 patients (aged 63.8±9.7 years, 50% female) were analysed. Of these, 17 (24.3%) had severe TR, 55 (78.6%) persistent AF and all restored sinus rhythm with catheter ablation. The primary outcome was achieved in 53 (75.7%) at 1-year assessment (73.6% of moderate and 82.4% of severe TR). There were significant decreases of vena contracta (6.1→3.2 mm) and tricuspid annular diameter (37.3→32.6 mm) at 1 year. Although 25 patients experienced AF recurrence within 1 year, 56 (80%) patients finally maintained sinus rhythm with medical treatment (87% in patients with TR reduction and 59% without). From the multivariate analysis, sinus rhythm maintenance was the most significant determinant of TR reduction (OR 8.3, 95% CI 1.8 to 37.4). CONCLUSION In patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction.
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Affiliation(s)
- Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Cardiac Imaging center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Min Soo Cho
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Kee-Joon Choi
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
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Baratto C, Caravita S, Corbetta G, Soranna D, Zambon A, Dewachter C, Gavazzoni M, Heilbron F, Tomaselli M, Radu N, Perelli FP, Perego GB, Vachiéry JL, Parati G, Badano LP, Muraru D. Impact of severe secondary tricuspid regurgitation on rest and exercise hemodynamics of patients with heart failure and a preserved left ventricular ejection fraction. Front Cardiovasc Med 2023; 10:1061118. [PMID: 36937944 PMCID: PMC10014840 DOI: 10.3389/fcvm.2023.1061118] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background Both secondary tricuspid regurgitation (STR) and heart failure with preserved ejection fraction (HFpEF) are relevant public health problems in the elderly population, presenting with potential overlaps and sharing similar risk factors. However, the impact of severe STR on hemodynamics and cardiorespiratory adaptation to exercise in HFpEF remains to be clarified. Aim To explore the impact of STR on exercise hemodynamics and cardiorespiratory adaptation in HFpEF. Methods We analyzed invasive hemodynamics and gas-exchange data obtained at rest and during exercise from HFpEF patients with severe STR (HFpEF-STR), compared with 1:1 age-, sex-, and body mass index (BMI)- matched HFpEF patients with mild or no STR (HFpEF-controls). Results Twelve HFpEF with atrial-STR (mean age 72 years, 92% females, BMI 28 Kg/m2) and 12 HFpEF-controls patients were analyzed. HFpEF-STR had higher (p < 0.01) right atrial pressure than HFpEF-controls both at rest (10 ± 1 vs. 5 ± 1 mmHg) and during exercise (23 ± 2 vs. 14 ± 2 mmHg). Despite higher pulmonary artery wedge pressure (PAWP) at rest in HFpEF-STR than in HFpEF-controls (17 ± 2 vs. 11 ± 2, p = 0.04), PAWP at peak exercise was no more different (28 ± 2 vs. 29 ± 2). Left ventricular transmural pressure and cardiac output (CO) increased less in HFpEF-STR than in HFpEF-controls (interaction p-value < 0.05). This latter was due to lower stroke volume (SV) values both at rest (48 ± 9 vs. 77 ± 9 mL, p < 0.05) and at peak exercise (54 ± 10 vs. 93 ± 10 mL, p < 0.05). Despite these differences, the two groups of patients laid on the same oxygen consumption isophlets because of the increased peripheral oxygen extraction in HFpEF-STR (p < 0.01). We found an inverse relationship between pulmonary vascular resistance and SV, both at rest and at peak exercise (R 2 = 0.12 and 0.19, respectively). Conclusions Severe STR complicating HFpEF impairs SV and CO reserve, leading to pulmonary vascular de-recruitment and relative left heart underfilling, undermining the typical HFpEF pathophysiology.
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Affiliation(s)
- Claudia Baratto
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Giorgia Corbetta
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonella Zambon
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Italy
| | - Céline Dewachter
- Department of Cardiology, Hôpital Académique Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Mara Gavazzoni
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Michele Tomaselli
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Noela Radu
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesco Paolo Perelli
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Jean-Luc Vachiéry
- Department of Cardiology, Hôpital Académique Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Gianfranco Parati
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luigi P. Badano
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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L'Official G, Vely M, Kosmala W, Galli E, Guerin A, Chen E, Sportouch C, Dreyfus J, Oger E, Donal E. Isolated functional tricuspid regurgitation: how to define patients at risk for event? ESC Heart Fail 2023; 10:1605-1614. [PMID: 36811285 DOI: 10.1002/ehf2.14189] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 02/24/2023] Open
Abstract
AIMS Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events. METHODS AND RESULTS We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm2 ) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow-up. The primary outcome was all-cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular-pulmonary arterial coupling, were 73 mL/m2 and 0.40 vs. 64.7 mL/m2 and 0.50 in the event vs. event-free groups, respectively (both P < 0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. The multivariable analysis leads to a model including TAPSE/sPAP ratio > 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m2 (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation. CONCLUSIONS RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow-up in patients with an isolated functional TR.
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Affiliation(s)
- Guillaume L'Official
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Mathilde Vely
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Wojciech Kosmala
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Anne Guerin
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Elisabeth Chen
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | | | | | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
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Hu Q, You H, Chen K, Dai Y, Lu W, Li Y, Cheng C, Zhou Y, Wang J, Chen R, Zhang S. Distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: Effects on postoperative tricuspid regurgitation deterioration. Heart Rhythm 2023; 20:217-223. [PMID: 36347456 DOI: 10.1016/j.hrthm.2022.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/07/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is an alternative strategy for His-bundle pacing (HBP); however, little is known about tricuspid regurgitation (TR) deterioration after LBBP implantation. OBJECTIVES The purpose of this study was to characterize the incidence of post-LBBP TR deterioration and identify predicting factors, especially lead position parameters. METHODS Patients who received LBBP were continuously enrolled from January 2018 to August 2020. The progression of TR and the anatomic position of LBBP were characterized by echocardiography. RESULTS A total of 89 patients were enrolled and assigned to 2 subgroups based on the degree of TR before LBBP implantation: 58 (65.2%) with relatively normal tricuspid valve (TV) function (grade 0/1 subgroup: with none/trivial or mild TR) and 31 (34.8%) with more severe TR (grade 2/3 subgroup: with moderate or severe TR). At 19.0 ± 6.5 months of follow-up, 29 patients (32.6%) had TR deterioration, and 23 of them were in the grade 0/1 subgroup. In the grade 0/1 subgroup, patients with TR deterioration had a shorter distance between the lead-implanted site and TV (Lead-TA-dist) than those without TR (19.0 ± 7.6 vs 23.9 ± 5.4; P = .006). The receiver operating characteristic (ROC) curve (area under the curve 0.721; 95% confidence interval [CI] 0.575-0.867; P = .005) indicated the favorable efficacy of Lead-TA-dist for predicting TR deterioration after LBBP. Lead-TA-dist ≤16.1 mm was independently associated with TR deterioration after LBBP (hazard ratio 0.20; 95% CI 0.06-0.76; P = .017). CONCLUSION TR was a common complication of LBBP implantation. In patients with none/trivial or mild TR, Lead-TA-dist ≤16.1 mm was an independent predictor of TR deterioration after LBBP implantation.
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Affiliation(s)
- Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhao You
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Endocrine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu'an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Wang
- Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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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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Singulane CC, Singh A, Addetia K, Yamat M, Lang RM. Developing Insights Regarding Tricuspid Valve Regurgitation: Morphology, Assessment of Severity, and the Need for a Novel Grading Scheme. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100026. [PMID: 37273466 PMCID: PMC10236825 DOI: 10.1016/j.shj.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/17/2022] [Indexed: 06/06/2023]
Abstract
Current understanding that progressive tricuspid regurgitation (TR) is associated with worse outcomes has highlighted the clinical need for a more accurate assessment of TR morphology and severity. This need has been further emphasized owing to the development of a myriad of percutaneous right-sided interventions, which may offer successful treatment of TR in selected patients. Understanding the etiology and quantification of the severity of TR has important implications in the selection of novel therapeutic strategies, i.e., medical vs. percutaneous vs. surgical approaches. Newer grading schemas that better reflect the TR lesion severity have been recently proposed and may facilitate monitoring of the evolution of TR following percutaneous and/or surgical treatment. In this review, we summarize contemporary concepts regarding tricuspid valve morphology, TR etiology, and associated mechanisms and echocardiographic approaches to grade TR severity.
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Affiliation(s)
| | | | | | | | - Roberto Miguel Lang
- Address correspondence to: Roberto Miguel Lang, MD, FASE, FACC, The University of Chicago Medicine, 5758 S. Maryland Avenue, MR 9067, DCAM 5509, Chicago, IL 6063
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Russo G, Taramasso M, Pedicino D, Gennari M, Gavazzoni M, Pozzoli A, Muraru D, Badano LP, Metra M, Maisano F. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities? Eur J Heart Fail 2021; 24:442-454. [PMID: 34894039 DOI: 10.1002/ejhf.2398] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/08/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mara Gavazzoni
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Denisa Muraru
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Volpato V, Badano LP, Figliozzi S, Florescu DR, Parati G, Muraru D. Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve. Curr Opin Cardiol 2021; 36:513-524. [PMID: 34292179 PMCID: PMC9904443 DOI: 10.1097/hco.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers. RECENT FINDINGS Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians. SUMMARY This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
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Affiliation(s)
- Valentina Volpato
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Stefano Figliozzi
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Diana R. Florescu
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
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Muraru D, Addetia K, Guta AC, Ochoa-Jimenez RC, Genovese D, Veronesi F, Basso C, Iliceto S, Badano LP, Lang RM. Right atrial volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation: a three-dimensional echocardiographic study. Eur Heart J Cardiovasc Imaging 2021; 22:660-669. [PMID: 33387441 DOI: 10.1093/ehjci/jeaa286] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to explore the relationships of tricuspid annulus area (TAA) with right atrial maximal volume (RAVmax) and right ventricular end-diastolic volume (RVEDV) in healthy subjects and patients with functional tricuspid regurgitation (FTR) of different aetiologies and severities. METHODS AND RESULTS We enrolled 280 patients (median age 66 years, 59% women) with FTR due to left heart disease (LHD), pulmonary hypertension (PH), corrected tetralogy of Fallot (TOF), chronic atrial fibrillation (AF), and 210 healthy volunteers (45 years, 53% women). We measured TAA at mid-systole and end-diastole, tenting volume of tricuspid leaflets, RAVmax, and RVEDV by 3D echocardiography. Irrespective of TA measurement timing, TAA correlated more closely with RAVmax than with RVEDV in both controls and FTR patients. On multivariable analysis, RAVmax was the most important determinant of TAA, accounting for 41% (normals) and 56% (FTR) of TAA variance. In FTR patients, age, RVEDV, and left ventricular ejection fraction were also independently correlated with TAA. RAVmax (AUC = 0.81) and TAA (AUC = 0.78) had a greater ability than RVEDV (AUC = 0.72) to predict severe FTR (P < 0.05). Among FTR patients, those with AF had the largest RAVmax and smallest RVEDV. RAVmax and TA were significantly dilated in all FTR groups, except in TOF. PH and TOF had largest RVEDV, yet tenting volume was increased only in PH and LHD. CONCLUSION RA volume is a major determinant of TAA, and RA enlargement is an important mechanism of TA dilation in FTR irrespective of cardiac rhythm and RV loading conditions.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Piazzale Brescia 20, Milan 20149, Italy
| | - Karima Addetia
- Department of Medicine, Section of Cardiology, University of Chicago, 5801 S Ellis Ave, Chicago 60637, IL, USA
| | - Andrada C Guta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.,Department of Internal Medicine - Cardiology, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Roberto C Ochoa-Jimenez
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.,Internal Medicine Department, Mount Sinai St. Luke and Mount Sinai West, 10025 New York, NY, USA
| | - Davide Genovese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Federico Veronesi
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Via Zamboni 33, Bologna 40126, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Piazzale Brescia 20, Milan 20149, Italy
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago, 5801 S Ellis Ave, Chicago 60637, IL, USA
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Donal E, Leurent G, Iung B. Are We Right to Believe in the Value of Transcatheter Treatment of Secondary Tricuspid Regurgitation? J Am Coll Cardiol 2021; 77:240-242. [PMID: 33478647 DOI: 10.1016/j.jacc.2020.11.037] [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: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes, France.
| | - Guillaume Leurent
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes, France
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Université de Paris, Paris, France
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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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