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Melillo F, Fabiani D, Santoro A, Oro P, Frecentese F, Salemme L, Tesorio T, Agricola E, De Bonis M, Lorusso R. Multimodality Imaging for Right Ventricular Function Assessment in Severe Tricuspid Regurgitation. J Clin Med 2024; 13:5076. [PMID: 39274289 PMCID: PMC11395915 DOI: 10.3390/jcm13175076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank-Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR.
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Affiliation(s)
- Francesco Melillo
- Heart and Vascular Centre, Cardiovascular Research Institute, University of Maastricht, 6221 Maastricht, The Netherlands
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Dario Fabiani
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Alessandro Santoro
- Intensive Care Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Pietro Oro
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | | | - Luigi Salemme
- Interventional Cardiology Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Tullio Tesorio
- Interventional Cardiology Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | | | - Michele De Bonis
- Heart Valve Centre, IRCCS Ospdeale San Raffaele, 20132 Milan, Italy
| | - Roberto Lorusso
- Heart and Vascular Centre, Cardiovascular Research Institute, University of Maastricht, 6221 Maastricht, The Netherlands
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2
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Mattig I, Romero Dorta E, Fitch K, Lembcke A, Dewey M, Stangl K, Dreger H. Predictors of residual tricuspid regurgitation after interventional therapy: an automated deep-learning CT analysis. Sci Rep 2024; 14:19946. [PMID: 39198524 PMCID: PMC11358455 DOI: 10.1038/s41598-024-70768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
Computed tomography (CT) is used as a valuable tool for device selection for interventional therapy in tricuspid regurgitation (TR). We aimed to evaluate predictors of TR reduction using CT and automated deep learning algorithms. Patients with severe to torrential TR and CTs prior to either percutaneous annuloplasty (PA) or tricuspid transcatheter edge-to-edge repair (T-TEER) were enrolled. CTs were analyzed using automated deep learning algorithms to assess tricuspid valve anatomy, right heart morphology, and function. Outcome parameters comprised post-interventional TR ≤ 1 and all-cause mortality. 84 patients with T-TEER (n = 32) or PA treatment (n = 52) were enrolled. Patients with a post-interventional TR ≤ 1 presented lower tenting heights and smaller tenting angles compared to patients with a TR > 1. Tenting height showed the best accuracy for post-interventional TR > 1 with an AUC of 0.756 (95% CI 0.560-0.951) in the T-TEER and 0.658 (95% CI 0.501-0.815) in the PA group, consistent with a suggested threshold of 6.8 mm and 9.2 mm, respectively. Patients with a post-interventional TR ≤ 1 exhibited a mortality of 4% and those with a TR > 1 of 12% during a follow-up of 331 ± 300 and 370 ± 265 days, respectively (p = 0.124). To conclude, tenting is associated with procedural outcomes and should be considered during screening for interventional TR therapy.
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Affiliation(s)
- Isabel Mattig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Elena Romero Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Alexander Lembcke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin University Alliance, BAU, Berlin, Germany
| | - Karl Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Henryk Dreger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Structural Heart Intervention Program (SHIP), Deutsches Herzzentrum der Charité, Berlin, Germany.
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3
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Synetos A, Ktenopoulos N, Katsaros O, Vlasopoulou K, Korovesis T, Drakopoulou M, Apostolos A, Koliastasis L, Toutouzas K, Tsioufis C. New Therapeutic Advances in the Management of Tricuspid Valve Regurgitation. J Clin Med 2024; 13:4599. [PMID: 39200742 PMCID: PMC11354245 DOI: 10.3390/jcm13164599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/21/2024] [Accepted: 08/03/2024] [Indexed: 09/02/2024] Open
Abstract
Tricuspid regurgitation (TR) is an intricate disorder that has a negative outlook, while surgical treatment is linked to increased mortality. Primary TR occurs due to a structural defect in the tricuspid valve (TV), while secondary TR is a more prevalent condition often associated with pulmonary hypertension, heart failure, and atrial fibrillation. The use of specific surgical procedures to improve TR is limited in everyday clinical practice due to the heightened surgical risk and delayed patient presentation. The development of other transcatheter heart valve procedures has led to a significant increase in transcatheter TV operations, which can be attributed to certain technological advancements. This review aims to provide an updated overview of transcatheter TV procedures, available alternative therapies, and standards for patient selection. It will also highlight the current state of development in this field, which is characterized by rapid progress and numerous ongoing clinical trials.
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Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
- School of Medicine, European University of Cyprus, Egkomi 2404, Cyprus
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Konstantina Vlasopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Constantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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5
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Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A, Bowers MT, Masri SC, Atluri P, Chikwe J, Mason PJ, Kovacic JC, Dangas GD. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1223-e1238. [PMID: 38660790 DOI: 10.1161/cir.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.
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6
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Stocker TJ, Hausleiter J. [Clinical aspects and treatment of tricuspid valve regurgitation]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:447-455. [PMID: 38568315 DOI: 10.1007/s00108-024-01692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/30/2024]
Abstract
Tricuspid regurgitation (TR) leading to right heart failure is prevalent and associated with increased mortality. The significant under-recognition of the disease resulted from insufficient medical therapies and the high associated risk of surgical therapy. Over the last decade there has been a rapid development of interventional treatment options so that the disease has increasingly become the focus of attention of specialists in internal medicine and interventional cardiologists. The etiology of TR is differentiated into primary TR, secondary atrial TR, secondary ventricular TR and TR associated with cardiac implantable electronic devices (CIED). The TR was identified as an independent predictor of mortality, independent of associated diseases such as atrial fibrillation, left-sided heart failure or pulmonary hypertension. Even patients with low to moderate TR have a significantly increased risk of mortality. Early diagnostics and estimation of the severity by echocardiography as well as timely referral to a tertiary heart valve center are decisive in order to evaluate possible treatment options before irreversible right ventricular damage and secondary organ dysfunction occur. For transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement there is now first evidence from randomized controlled studies. While the understanding of TR is continuously improving, new tricuspid valve repair and replacement systems are in a state of steady progress. Whether the treatment has an effect on reduction of the mortality and stabilization of right ventricular failure with a reduction in hospitalization, will first be shown in future studies.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnerstandort Munich Heart Alliance, München, Deutschland.
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnerstandort Munich Heart Alliance, München, Deutschland.
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7
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Mariani M, Bonanni M, D'Agostino A, Iuliano G, Gimelli A, Coceani MA, Celi S, Sangiorgi GM, Berti S. Multimodality Imaging Approach for Planning and Guiding Direct Transcatheter Tricuspid Valve Annuloplasty. J Am Soc Echocardiogr 2024; 37:449-465. [PMID: 38286242 DOI: 10.1016/j.echo.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
Interest in transcatheter treatment of tricuspid regurgitation (TR) has grown significantly in recent years due to increasing evidence correlating TR severity with mortality and to limited availability of surgical options often considered high-risk in these patients. Although edge-to-edge repair is currently the main transcatheter therapeutic strategy, tricuspid valve direct annuloplasty can also be performed safely and effectively to reduce TR and improve heart failure symptoms and quality of life. In the annuloplasty procedure, an adjustable band is implanted around the tricuspid annulus to reduce valvular size and improve TR. Patient selection and careful preoperative imaging, including transthoracic echocardiography, transesophageal echocardiography, and computed tomography, are critical for procedural success and proper device implantation. Compared to edge-to-edge repair, perioperative imaging with transesophageal echocardiography and fluoroscopy is particularly challenging. Alignment and insertion of the anchors are demanding but essential to achieve good results and avoid damaging the surrounding structures. The presence of shadowing artifacts due to cardiac devices makes the acquisition of good-quality images even more challenging. In this review, we discuss the current role of multimodality imaging in planning direct transcatheter tricuspid valve annuloplasty and describe all procedural steps focusing on echocardiographic monitoring.
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Affiliation(s)
| | - Michela Bonanni
- Adult Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy; Department of Biomedicine and Prevention, Policlinico Tor Vergata, Roma, Italy
| | | | - Giuseppe Iuliano
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Alessia Gimelli
- Department of Cardiac Imaging, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Simona Celi
- BioCardioLab, Bioengineering Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Sergio Berti
- Adult Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
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8
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Windecker S, Gilard M, Achenbach S, Cribier A, Delgado V, Deych N, Drossart I, Eltchaninoff H, Fraser AG, Goncalves A, Hindricks G, Holborow R, Kappetein AP, Kilmartin J, Kurucova J, Lüscher TF, Mehran R, O'Connor DB, Perkins M, Samset E, von Bardeleben RS, Weidinger F. Device innovation in cardiovascular medicine: a report from the European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2024; 45:1104-1115. [PMID: 38366821 DOI: 10.1093/eurheartj/ehae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning. There is a need to foster an environment conducive to medical technology development and validation so that Europe can continue to play a major role in device innovation while providing high standards of safety. This paper summarizes viewpoints on the topic of device innovation in cardiovascular medicine at the European Society of Cardiology Cardiovascular Round Table, a strategic forum for high-level dialogue to discuss issues related to the future of cardiovascular health in Europe. Devices are developed and improved through an iterative process throughout their lifecycle. Early feasibility studies demonstrate proof of concept and help to optimize the design of a device. If successful, this should ideally be followed by randomized clinical trials comparing novel devices vs. accepted standards of care when available and the collection of post-market real-world evidence through registries. Unfortunately, standardized procedures for feasibility studies across various device categories have not yet been implemented in Europe. Cardiovascular imaging can be used to diagnose and characterize patients for interventions to improve procedural results and to monitor devices long term after implantation. Randomized clinical trials often use cardiac imaging-based inclusion criteria, while less frequently trials randomize patients to compare the diagnostic or prognostic value of different modalities. Applications using machine learning are increasingly important, but specific regulatory standards and pathways remain in development in both Europe and the USA. Standards are also needed for smart devices and digital technologies that support device-driven biomonitoring. Changes in device regulation introduced by the European Union aim to improve clinical evidence, transparency, and safety, but they may impact the speed of innovation, access, and availability. Device development programmes including dialogue on unmet needs and advice on study designs must be driven by a community of physicians, trialists, patients, regulators, payers, and industry to ensure that patients have access to innovative care.
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Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Martine Gilard
- Département de Cardiologie, Hospital La Cavale Blanche, La Cavale Blanche Hospital Boulevard Tanguy Prigent, 29200 Brest, France
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Germany
| | - Alain Cribier
- Department of Cardiology, Inserm U1096, Univ Rouen Normandie, F-76000 Rouen, France
| | - Victoria Delgado
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nataliya Deych
- Regulatory Affairs, Edwards Lifesciences, Nyon, Switzerland
| | | | - Hélène Eltchaninoff
- Department of Cardiology, University Hospital Charles Nicolle, Rouen, France
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Alexandra Goncalves
- Precision Diagnostics, Philips, Cambridge, MA, USA
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto Medical School, Porto, Portugal
| | - Gerhard Hindricks
- Department of Cardiology, German Heart Center Charite, Berlin, Germany
| | | | | | | | - Jana Kurucova
- Transcatheter Heart Valve Division, Edwards Lifesciences, Nyon, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College and King's College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Roxana Mehran
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | | | - Mark Perkins
- GE Healthcare Cardiology Solutions, Harrogate, UK
| | - Eigil Samset
- GE Healthcare Cardiology Solutions, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
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9
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Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M, Cavalcante JL, de Potter T, Doenst T, Friedrichs K, Hausleiter J, Karam N, Kodali S, Latib A, Marijon E, Mittal S, Nickenig G, Rinaldi A, Rudzinski PN, Russo M, Starck C, von Bardeleben RS, Wunderlich N, Zamorano JL, Hahn RT, Maisano F, Leclercq C. Tricuspid valve disease and cardiac implantable electronic devices. Eur Heart J 2024; 45:346-365. [PMID: 38096587 PMCID: PMC10834167 DOI: 10.1093/eurheartj/ehad783] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Level 7C, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Departement, University Hospital of Geneva, Geneva, Switzerland
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Osama Soliman
- Discipline of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive, and University of Galway, Galway H91 YR71, Ireland
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Manuel Barreiro
- Cardiology Department, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - João L Cavalcante
- Cardiac MR and Structural CT lab, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rine Westphalia, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik I, Ludwig-Maximilians-University, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Paris Cité, Paris, France
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, NewYork, NY, USA
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Suneet Mittal
- Department of Cardiology, The Valley Health System, the Synder Comprehensive Center for Atrial Fibrillation, Ridgewood, NJ, USA
| | - Georg Nickenig
- Herzzentrum Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Aldo Rinaldi
- Department of Cardiology, Guy’s & St Thomas’ NHS Trust, London, UK
| | - Piotr Nikodem Rudzinski
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Universitätsmedizin Mainz of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Nina Wunderlich
- Department of Cardiology/Angiology, Asklepios Klinik Langen, Langen, Germany
| | - José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU Rennes, lTSI-UMR1099, Rennes F-35000, France
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10
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Samim D, Dernektsi C, Brugger N, Reineke D, Praz F. Contemporary Approach to Tricuspid Regurgitation: Knowns, Unknowns, and Future Challenges. Can J Cardiol 2024; 40:185-200. [PMID: 38052301 DOI: 10.1016/j.cjca.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late, and tricuspid valve interventions (surgical or transcatheter) are underutilised, which may lead to irreversible right ventricular damage and increases risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomised controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared with medical treatment.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Chrisoula Dernektsi
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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11
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Chamberlin JH, Baruah D, Smith C, McGuire A, Maisuria D, Kabakus IM. Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review. Semin Roentgenol 2024; 59:7-19. [PMID: 38388099 DOI: 10.1053/j.ro.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Jordan H Chamberlin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
| | - Carter Smith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Aaron McGuire
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhruw Maisuria
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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12
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Hell MM, Emrich T, Lurz P, von Bardeleben RS, Schmermund A. Cardiac CT Beyond Coronaries: Focus on Structural Heart Disease. Curr Heart Fail Rep 2023; 20:484-492. [PMID: 38019324 PMCID: PMC10746749 DOI: 10.1007/s11897-023-00635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW Cardiac computed tomography (CT) is an established non-invasive imaging tool for the assessment of coronary artery disease. Furthermore, it plays a key role in the preinterventional work-up of patients presenting with structural heart disease. RECENT FINDINGS CT is the gold standard for preprocedural annular assessment, device sizing, risk determination of annular injury, coronary occlusion or left ventricular outflow tract obstruction, calcification visualization and quantification of the target structure, and prediction of a co-planar fluoroscopic angulation for transcatheter interventions in patients with structural heart disease. It is further a key imaging modality in postprocedural assessment for prosthesis thrombosis, degeneration, or endocarditis. CT plays an integral part in the imaging work-up of novel transcatheter therapies for structural heart disease and postprocedural assessment for prosthesis thrombosis or endocarditis. This review provides a comprehensive overview of the key role of CT in the context of structural heart interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | | | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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13
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Xu H, Li W, Lee APW, Wu S, Husanova F, Wu B, Mou Y, Gu Y, Chen M, Tao T, Zhang Y, Zheng J, Yang A, Yuan S, Wang Q, Ni Y, Ma L. 30-Day Outcomes of Transcatheter Tricuspid Annuloplasty With the K-Clip System: A Single-Center, Observational Study. JACC. ADVANCES 2023; 2:100671. [PMID: 38938712 PMCID: PMC11198610 DOI: 10.1016/j.jacadv.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 06/29/2024]
Abstract
Background Surgery for isolated functional tricuspid regurgitation (TR) poses a high risk. Several transcatheter approaches are being evaluated for the treatment of such patients. The K-Clip system is a percutaneous approach designed for functional TR; however, its utility remains unknown. Objectives This study aimed to report the 30-day echocardiographic and clinical outcomes with the K-Clip system for severe TR, including changes in TR severity and NYHA functional class. Methods Transcatheter tricuspid valve annuloplasty was performed in 39 patients with intermediate or high surgical risk who underwent the K-Clip system. The right internal jugular vein procedure was performed with annuloplasty guided by fluoroscopy and echocardiography. The primary outcomes were clinical success and all-cause mortality at the 30-day follow-up. Results The K-Clip was successfully implanted in all cases, with 1 to 3 devices deployed. At the 30-day follow-up, none of the patients had died. TR severity was reduced by at least one grade in all patients. There were no severe procedural or 30-day adverse events, except for 1 new pacemaker implantation. The proportion of NYHA class III-IV patients decreased from 79.5% to 5.1%, and the ascites disappeared. The 6-minute walk distance increased by 78 m (P < 0.05), and the Kansas City Cardiomyopathy Questionnaire score improved by 11 points (P < 0.05). Conclusions The K-Clip device is practical, safe, and effective for patients with severe TR. A 30-day reduction in TR and enhanced cardiac function and quality of life were associated with transcatheter tricuspid annuloplasty using the K-Clip device, according to short-term follow-up studies. (Confirmatory Clinical Study of Treating Tricuspid Regurgitation With K-Clip TM Transcatheter Annuloplasty System [TriStar]; NCT05173233).
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Affiliation(s)
- Hongfei Xu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Shengjun Wu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Firyuza Husanova
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Bifeng Wu
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yun Mou
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanjia Gu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Miao Chen
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Tingting Tao
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yiran Zhang
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Junnan Zheng
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Anqi Yang
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shuai Yuan
- Echocardiography and Vascular Ultrasound Center, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qing Wang
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
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14
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Anastasiou V, Bazmpani MA, Daios S, Moysidis DV, Zegkos T, Didagelos M, Karamitsos T, Toutouzas K, Ziakas A, Kamperidis V. Unmet Needs in the Assessment of Right Ventricular Function for Severe Tricuspid Regurgitation. Diagnostics (Basel) 2023; 13:2885. [PMID: 37761251 PMCID: PMC10529663 DOI: 10.3390/diagnostics13182885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease that has been long overlooked, but lately its independent association with adverse cardiovascular outcomes was recognized. The time point to intervene and repair the tricuspid valve is defined by the right ventricular (RV) dilation and dysfunction that comes up at a later stage. While guidelines favor tricuspid valve repair before severe RV dysfunction ensues, the definition of RV dysfunction in a universal manner remains vague. As a result, the candidates for transcatheter or surgical TR procedures are often referred late, when advanced RV dysfunction is established, and any derived procedural survival benefit is attenuated. Thus, it is of paramount importance to establish a universal means of RV function assessment in patients with TR. Conventional echocardiographic indices of RV function routinely applied have fundamental flaws that limit the precise characterization of RV performance. More recently, novel echocardiographic indices such as strain via speckle-tracking have emerged, demonstrating promising results in the identification of early RV damage. Additionally, evidence of the role of alternative imaging modalities such as cardiac computed tomography and cardiac magnetic resonance, for RV functional assessment in TR, has recently arisen. This review provides a systematic appraisal of traditional and novel multimodality indices of RV function in severe TR and aims to refine RV function assessment, designate future directions, and ultimately, to improve the outcome of patients suffering from severe TR.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Maria-Anna Bazmpani
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Theodoros Karamitsos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
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15
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Miyagi C, Ahmad M, Karimov JH, Polakowski AR, Karamlou T, Yaman M, Fukamachi K, Najm HK. Human fitting of pediatric and infant continuous-flow total artificial heart: visual and virtual assessment. Front Cardiovasc Med 2023; 10:1193800. [PMID: 37529709 PMCID: PMC10387526 DOI: 10.3389/fcvm.2023.1193800] [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: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background This study aimed to determine the fit of two small-sized (pediatric and infant) continuous-flow total artificial heart pumps (CFTAHs) in congenital heart surgery patients. Methods This study was approved by Cleveland Clinic Institutional Review Board. Pediatric cardiac surgery patients (n = 40) were evaluated for anatomical and virtual device fitting (3D-printed models of pediatric [P-CFTAH] and infant [I-CFTAH] models). The virtual sub-study consisted of analysis of preoperative thoracic radiographs and computed tomography (n = 3; 4.2, 5.3, and 10.2 kg) imaging data. Results P-CFTAH pump fit in 21 out of 40 patients (fit group, 52.5%) but did not fit in 19 patients (non-fit group, 47.5%). I-CFTAH pump fit all of the 33 patients evaluated. There were critical differences due to dimensional variation (p < 0.0001) for the P-CFTAH, such as body weight (BW), height (Ht), and body surface area (BSA). The cutoff values were: BW: 5.71 kg, Ht: 59.0 cm, BSA: 0.31 m2. These cutoff values were additionally confirmed to be optimal by CT imaging. Conclusions This study demonstrated the range of proper fit for the P-CFTAH and I-CFTAH in congenital heart disease patients. These data suggest the feasibility of both devices for fit in the small-patient population.
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Affiliation(s)
- Chihiro Miyagi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
| | - Munir Ahmad
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Anthony R. Polakowski
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Malek Yaman
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH, United States
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Hani K. Najm
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
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16
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Affiliation(s)
- Rebecca T Hahn
- From the Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
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17
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Cammalleri V, Antonelli G, De Luca VM, Carpenito M, Nusca A, Bono MC, Mega S, Ussia GP, Grigioni F. Functional Mitral and Tricuspid Regurgitation across the Whole Spectrum of Left Ventricular Ejection Fraction: Recognizing the Elephant in the Room of Heart Failure. J Clin Med 2023; 12:jcm12093316. [PMID: 37176756 PMCID: PMC10178924 DOI: 10.3390/jcm12093316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) occur due to cardiac remodeling in the presence of structurally normal valve apparatus. Two main mechanisms are involved, distinguishing an atrial functional form (when annulus dilatation is predominant) and a ventricular form (when ventricular remodeling and dysfunction predominate). Both affect the prognosis of patients with heart failure (HF) across the entire spectrum of left ventricle ejection fraction (LVEF), including preserved (HFpEF), mildly reduced (HFmrEF), or reduced (HFrEF). Currently, data on the management of functional valve regurgitation in the various HF phenotypes are limited. This review summarizes the epidemiology, pathophysiology, and treatment of FMR and FTR within the different patterns of HF, as defined by LVEF.
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Affiliation(s)
- Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Giorgio Antonelli
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Valeria Maria De Luca
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Myriam Carpenito
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Annunziata Nusca
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Maria Caterina Bono
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Simona Mega
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
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18
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Cammalleri V, Nobile E, De Stefano D, Carpenito M, Mega S, Bono MC, De Filippis A, Nusca A, Quattrocchi CC, Grigioni F, Ussia GP. Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures. J Clin Med 2023; 12:jcm12051712. [PMID: 36902497 PMCID: PMC10003433 DOI: 10.3390/jcm12051712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Cardiac computed tomography (CT) provides important insights into the geometrical configuration of the tricuspid valve (TV). The purpose of the present study was to assess the geometrical changes of TV in patients with functional tricuspid regurgitation (TR) using novel CT scan parameters and to correlate these findings with echocardiography. METHODS This single-center study enrolled 86 patients undergoing cardiac CT and divided them into two groups according to the presence or not of severe TR (43 patients with TR ≥ 3+ and 43 controls). The measurements collected were as follows: TV annulus area and perimeter, septal-lateral and antero-posterior annulus diameters, eccentricity, distance between commissures, segment between the geometrical centroid and commissures, and the angles of commissures. RESULTS We found a significant correlation between all annulus measurements and the grade of TR, except in regard to angles. TR ≥ 3+ patients had significantly larger TV annulus area and perimeter, larger septal-lateral, and antero-posterior annulus dimensions, as well as larger commissural distance and centroid-commissural distance. In patients with TR ≥ 3+ and controls, the eccentricity index predicted a circular shape and an oval shape of the annulus, respectively. CONCLUSIONS These novel CT variables focusing on commissures increase the anatomical understanding of the TV apparatus and the TV geometrical changes in patients with severe functional TR.
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Affiliation(s)
- Valeria Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Correspondence: (V.C.); (G.P.U.); Tel.: +39-062-2541-1612 (V.C.)
| | - Edoardo Nobile
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Domenico De Stefano
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Myriam Carpenito
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Simona Mega
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Maria Caterina Bono
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Aurelio De Filippis
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Annunziata Nusca
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Correspondence: (V.C.); (G.P.U.); Tel.: +39-062-2541-1612 (V.C.)
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Tully A, Tom S, Xie J, O'Brian C, Gleason P, Grubb KJ. Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies. J Card Surg 2022; 37:4124-4132. [PMID: 36168827 DOI: 10.1111/jocs.16977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre-procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the "TAVR CT," facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth.
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Affiliation(s)
- Andrew Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Joe Xie
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Colin O'Brian
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
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Rudzinski PN, Leipsic JA, Schoepf UJ, Dudek D, Schwarz F, Andreas M, Zlahoda-Huzior A, Thilo C, Renker M, Burt JR, Emrich T, Varga-Szemes A, Amoroso NS, Steinberg DH, Pukacki P, Demkow M, Kepka C, Bayer RR. CT in Transcatheter-delivered Treatment of Valvular Heart Disease. Radiology 2022; 304:4-17. [PMID: 35638923 DOI: 10.1148/radiol.210567] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Minimally invasive strategies to treat valvular heart disease have emerged over the past 2 decades. The use of transcatheter aortic valve replacement in the treatment of severe aortic stenosis, for example, has recently expanded from high- to low-risk patients and became an alternative treatment for those with prohibitive surgical risk. With the increase in transcatheter strategies, multimodality imaging, including echocardiography, CT, fluoroscopy, and cardiac MRI, are used. Strategies for preprocedural imaging strategies vary depending on the targeted valve. Herein, an overview of preprocedural imaging strategies and their postprocessing approaches is provided, with a focus on CT. Transcatheter aortic valve replacement is reviewed, as well as less established minimally invasive treatments of the mitral and tricuspid valves. In addition, device-specific details and the goals of CT imaging are discussed. Future imaging developments, such as peri-procedural fusion imaging, machine learning for image processing, and mixed reality applications, are presented.
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Affiliation(s)
- Piotr Nikodem Rudzinski
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jonathon A Leipsic
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Dariusz Dudek
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Florian Schwarz
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Martin Andreas
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Adriana Zlahoda-Huzior
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Christian Thilo
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Matthias Renker
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jeremy R Burt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Nicholas S Amoroso
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Daniel H Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Piotr Pukacki
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Marcin Demkow
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Cezary Kepka
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Richard R Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
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Cammalleri V, Carpenito M, De Stefano D, Ussia GP, Bono MC, Mega S, Nusca A, Cocco N, Nobile E, De Filippis A, Vitez L, Quattrocchi CC, Grigioni F. Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study. J Clin Med 2022; 11:jcm11102825. [PMID: 35628951 PMCID: PMC9143522 DOI: 10.3390/jcm11102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. METHODS This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. RESULTS A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. CONCLUSIONS These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies.
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Affiliation(s)
- Valeria Cammalleri
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
- Correspondence: or ; Tel.: +39-06225-411-612
| | - Myriam Carpenito
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Domenico De Stefano
- Unit of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Gian Paolo Ussia
- Unit of Interventional Cardiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (G.P.U.); (C.C.Q.)
| | - Maria Caterina Bono
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Simona Mega
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Annunziata Nusca
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Nino Cocco
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Edoardo Nobile
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Aurelio De Filippis
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Luka Vitez
- Department of Cardiology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia;
| | - Carlo Cosimo Quattrocchi
- Unit of Interventional Cardiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (G.P.U.); (C.C.Q.)
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
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Florescu DR, Muraru D, Volpato V, Gavazzoni M, Caravita S, Tomaselli M, Ciampi P, Florescu C, Bălșeanu TA, Parati G, Badano LP. Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore. J Clin Med 2022; 11:382. [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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Affiliation(s)
- Diana R. Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Valentina Volpato
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pellegrino Ciampi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy
| | - Cristina Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Tudor A. Bălșeanu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luigi P. Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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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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Cammalleri V, Carpenito M, Bono MC, Mega S, Ussia GP, Grigioni F. Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention. Front Cardiovasc Med 2021; 8:778445. [PMID: 34869692 PMCID: PMC8639182 DOI: 10.3389/fcvm.2021.778445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Nowadays, severe symptomatic tricuspid regurgitation (TR) affects millions of persons worldwide. However, the benefit of surgical correction of isolated secondary TR remains controversial because of the increased risk of periprocedural mortality and morbidity. In recent years, novel transcatheter tricuspid valve interventions (TTVI) were developed to treat TR, so that TTVI is currently considered in symptomatic, inoperable, anatomically eligible patients. TTVI can be divided into these five domains: edge-to-edge leaflet repair, tricuspid annuloplasty, caval implants, spacer, and total valve replacement. Each transcatheter intervention needs specific imaging protocols for assessing the anatomical feasibility and consequentially predicting the procedural success. This review summarizes the available multimodality imaging tools for screening patients with TR, and identifies anatomical characteristics to choose the best option for the patient.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Myriam Carpenito
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Maria Caterina Bono
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Simona Mega
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Right Heart Morphology of Candidate Patients for Transcatheter Tricuspid Valve Interventions. Cardiovasc Eng Technol 2021; 13:573-589. [PMID: 34854068 PMCID: PMC9499909 DOI: 10.1007/s13239-021-00595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022]
Abstract
Purpose This study quantitatively evaluated the phasic right heart morphology of candidate patients for a transcatheter tricuspid valve intervention (N=32) and of subjects with trace to no tricuspid regurgitation (N = 14). Methods Cardiac computed tomography angiography (CCTA) and transthoracic/transesophageal echocardiography (TTE/TEE) images were analyzed using dedicated research and clinical software. Using CCTA, the phasic right atrial and ventricular volumes, annulus dimensions, annulus-to-right coronary artery (RCA) distances, circumferential topography of the annular tissue shelf, vena cava dimensions (inferior and superior), vena cava positions, axis angles, and annular excursions were quantified. Using TTE/TEE, leaflet geometry, regurgitation, hemodynamics, and heart function were quantified. Measurements within and between groups were quantitatively compared with regression analyses to explore relationships between right heart features. Results The phasic position and orientation of the vena cava and the circumferential topography of the annular tissue shelf were quantitatively presented for the first time. The candidate patient group exhibited greater chamber dimensions, enlarged vena cava, distended vena cava positions, positional shallowing of the annular tissue shelf, geometric annular distortion, leaflet distention, moderate or greater regurgitation, and impaired ventricular function. Atrial volume correlated strongly with directional vena cava positions as well as with annular dimensions. Annulus-to-RCA distances and annular excursions were comparable between groups. Conclusions This study provides new and further insight to the right heart morphology and functional characteristics of candidate patients for a transcatheter tricuspid valve intervention. These data provide a platform from which these patients can continue to be better understood for further improving transcatheter system design and use. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00595-y.
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Layoun H, Schoenhagen P, Wang TKM, Puri R, Kapadia SR, Harb SC. Roles of Cardiac Computed Tomography in Guiding Transcatheter Tricuspid Valve Interventions. Curr Cardiol Rep 2021; 23:114. [PMID: 34269899 DOI: 10.1007/s11886-021-01547-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The field of transcatheter tricuspid valve interventions (TTVI) is rapidly evolving to meet a well-defined but unmet clinical need. Severe tricuspid regurgitation is common and is associated with significant morbidity and mortality. Surgical options are limited and of high risk. The success of TTVI depends on careful procedural planning, and cardiac computed tomography (CCT) plays an emerging key role. RECENT FINDINGS TTVI technologies have various targets, including the leaflets, annulus, and venae cavae, along with valve replacement. Based on the planned procedure, CCT allows for device sizing, careful assessment of the access route, and comprehensive analysis of relevant adjacent anatomic structures to enhance procedural safety. It can also evaluate right-sided heart function, and its data can be for fusion imaging and 3D printing. Procedural planning is key to TTVI's success and is highly dependent on high-quality CCT data. This review details the comprehensive roles of CCT, specifics of the dedicated TTVI protocol, and its limitations.
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Affiliation(s)
- Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Schmermund A, Breitbart P, Eckert J, Magedanz A, Schmidt M, Voigtländer T. 2020: Entwicklungen in der kardialen Computertomographie. DER KARDIOLOGE 2021. [PMCID: PMC7921831 DOI: 10.1007/s12181-021-00454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Die Entwicklung der kardialen Computertomographie (CT) im Jahr 2020 war durch 3 dominante Schwerpunkte im Bereich der koronaren Bildgebung gekennzeichnet: 1) die prognostische Bedeutung der Plaquebildung, 2) die Möglichkeit ihrer volumetrischen Quantifizierung und 3) den Bedeutungsgewinn in den Leitlinien, verstärkt durch die zunehmende Anwendung in der Therapie von strukturellen Herzerkrankungen. Die Veröffentlichung der Ergebnisse von ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) hat den Blick auf die anatomische Charakterisierung der koronaren Herzkrankheit gelenkt, die Visualisierung der koronaren Plaquebildung. Nicht zuletzt als Ergebnis von „machine learning“/künstlicher Intelligenz hat sich die Möglichkeit herauskristallisiert, die koronare Plaquebildung automatisiert und volumetrisch zu erfassen. Diese beiden Entwicklungen haben die Frage nach der prognostischen Dominanz des Ischämienachweises aufgeworfen, der sekundär aus der Plaquebildung resultiert. Auch hat sich das Verständnis der Pathophysiologie der koronaren Herzerkrankung verändert: Die Ausprägung des (nicht verkalkten) Plaquevolumens, seine Lokalisierung und Dynamik scheinen als Merkmale der Vulnerabilität im Vergleich zur Fokussierung auf ein großes Atherom oder expansives Remodeling einzelner Plaques bedeutsamer zu sein. In den Leitlinien ist die koronare CT-Angiographie (CTA) sowohl bei den akuten Koronarsyndromen ohne ST-Hebung als auch den chronischen Koronarsyndromen an die erste Stelle gerückt – gleichberechtigt mit den klassischen bildgebenden Ischämietests. Unabhängig davon gewinnt die kardiale CT zunehmend an Bedeutung für die Therapieplanung von Vitien (insbesondere der Aorten- und Trikuspidalklappe), aber auch anderer struktureller Herzerkrankungen (z. B. Verschluss des linken Vorhofohrs, LAA).
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Affiliation(s)
- Axel Schmermund
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Philipp Breitbart
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Joachim Eckert
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Annett Magedanz
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Marco Schmidt
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Thomas Voigtländer
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
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