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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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Ogawa M, Kuwajima K, Yamane T, Hasegawa H, Yagi N, Shiota T. Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033196. [PMID: 38609840 PMCID: PMC11262525 DOI: 10.1161/jaha.123.033196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. METHODS AND RESULTS We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. CONCLUSIONS Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
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Affiliation(s)
- Mana Ogawa
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
| | - Ken Kuwajima
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
| | - Takafumi Yamane
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
| | - Hiroko Hasegawa
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
| | - Nobuichiro Yagi
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
| | - Takahiro Shiota
- Cedars‐Sinai Medical CenterSmidt Heart InstituteLos AngelesCAUSA
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Molnár AÁ, Sánta A, Merkely B. Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography. Diagnostics (Basel) 2023; 13:2470. [PMID: 37568832 PMCID: PMC10416971 DOI: 10.3390/diagnostics13152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (A.S.); (B.M.)
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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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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; 12:3316. [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)
| | | | | | | | | | | | | | | | - 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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L'Official G, Vely M, Kosmala W, Galli E, Guerin A, Chen E, Sportouch C, Dreyfus J, Oger E, Donal E. Isolated functional tricuspid regurgitation: how to define patients at risk for event? ESC Heart Fail 2023; 10:1605-1614. [PMID: 36811285 DOI: 10.1002/ehf2.14189] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 02/24/2023] Open
Abstract
AIMS Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events. METHODS AND RESULTS We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm2 ) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow-up. The primary outcome was all-cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular-pulmonary arterial coupling, were 73 mL/m2 and 0.40 vs. 64.7 mL/m2 and 0.50 in the event vs. event-free groups, respectively (both P < 0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. The multivariable analysis leads to a model including TAPSE/sPAP ratio > 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m2 (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation. CONCLUSIONS RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow-up in patients with an isolated functional TR.
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Affiliation(s)
- Guillaume L'Official
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Mathilde Vely
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Wojciech Kosmala
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Anne Guerin
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Elisabeth Chen
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | | | | | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
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Cosyns B, Sade LE, Gerber BL, Gimelli A, Muraru D, Maurer G, Edvardsen T. The year 2021 in the European Heart Journal: Cardiovascular Imaging Part II. Eur Heart J Cardiovasc Imaging 2023; 24:276-284. [PMID: 36718129 DOI: 10.1093/ehjci/jeac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023] Open
Abstract
The European Heart Journal-Cardiovascular Imaging was launched in 2012 and has during these years become one of the leading multimodality cardiovascular imaging journals. The journal is currently ranked as Number 19 among all cardiovascular journals. It has an impressive impact factor of 9.130. The most important studies published in our Journal from 2021 will be highlighted in two reports. Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease, while Part I of the review has focused on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
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Affiliation(s)
- Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Leyla Elif Sade
- Cardiology Department, University of Pittsburgh, University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Delafield Rd Suite 3010 and 4050, Pittsburgh, PA 15215, USA.,University of Baskent, Department of Cardiology, Yukarı Bahçelievler, Mareşal Fevzi Çakmak Cd. No: 45, 06490 Çankaya/Ankara, Turkey
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana G. Monasterio, Department of Cardiac Imaging, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiology, Piazzale Brescia 20, Via Giuseppe Zucchi, 18, 20095 Cusano, Milanino MI, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
| | - Thor Edvardsen
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway and Institute for clinical medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway.,KG Jebsen Cardiac Research Centre, Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
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Donal E, Lancellotti P. A new score to stratify the risk in tricuspid regurgitation: the icing on the cake. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac068. [PMID: 36452183 PMCID: PMC9704114 DOI: 10.1093/ehjopen/oeac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erwan Donal
- Service de Cardiologie—Hôpital Pontchaillou, Univ Rennes, CHU Rennes,
Inserm, LTSI—UMR 1099, F-35033Rennes, France
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liege
Hospital, CHU Sart Tilman, Avenue de l'Hôpital, n°1, 4000
Liege, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital,
Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
- ruppo Villa Maria Care and Research, Maria Cecilia Hospital, Anthea
Hospital, Via C. Rosalba 35/37, 70124 Bari,
Italy
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Freixa X, Arzamendi D, Del Trigo M, Cepas-Guillén PL, Li P, Sanchis L, Barreiro M, Regueiro A, Baz JA, Asmarats L, Calvo F, Moñivas V, Meduiña I, Goicolea J, Sitges M, Estévez-Loureiro R. The TriClip system for edge-to-edge transcatheter tricuspid valve repair. A Spanish multicenter study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:797-804. [PMID: 35288060 DOI: 10.1016/j.rec.2022.01.007] [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: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES In patients with tricuspid regurgitation (TR), edge-to-edge transcatheter tricuspid valve repair (TTVR) is the strategy with the highest penetration worldwide. A dedicated edge-to-edge TTVR system has recently become available in Europe. The present study describes the initial experience with the system in Spain. METHODS This multicenter study collected individual data from the centers accepted for the use of the novel system within an initial limited release. Between June 2020 and March 2021, all patients undergoing an edge-to-edge TTVR using the TriClip system in Spain were included in the study. The primary endpoint was the achievement of a TR reduction of at least 1 grade at discharge. RESULTS We included 34 patients. Most of them reported a previous history of atrial fibrillation (91%) and only 1 had a pacemaker lead. The primary endpoint (TR reduction of at least 1 grade at discharge) was met in all patients. Most of the patients required 1 (47%) or 2 clips (44%) with a clear predominance of XT (87%) over NT (13%). The location of the first clip was anteroseptal in >90% of the patients. Only 1 patient had a partial detachment, which was stabilized with additional clips in the same procedure. At discharge, TR severity was≤2 in 91% of patients. At 3 months, mortality was nil. Overall, 88% of patients were in New York Heart Association functional class≤2 and 80% had residual TR≤2. CONCLUSIONS Edge-to-edge TTVR seemed to be effective and safe with a sustained TR reduction at 3 months. Further studies will be needed to confirm our findings.
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Affiliation(s)
- Xavier Freixa
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Luis Cepas-Guillén
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchis
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel Barreiro
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fran Calvo
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Vanessa Moñivas
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Irene Meduiña
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Goicolea
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Sitges
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Vely M, L'official G, Galli E, Kosmala W, Guerin A, Chen E, Sportouch C, Dreyfus J, Oger E, Donal E. Functional tricuspid regurgitation: A clustering analysis and prognostic validation of three echocardiographic phenotypes in an external cohort. Int J Cardiol 2022; 365:140-147. [PMID: 35853500 DOI: 10.1016/j.ijcard.2022.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation (FTR) is an independent risk factor for morbidity and mortality. New pathophysiological concepts but also new therapeutic options are justifying new knowledges for characterizing FTRs and their prognoses. AIM To study echocardiographic criteria associated with prognosis in FTR-patients using a clustering method in two cohorts. METHODS AND RESULTS Two hundred forty-one patients with at least severe (≥grade 3) TR were enrolled: 92 in the retrospective cohort (mean age 77.9 ± 13 years) and 149 in the prospective validation cohort. Hierarchical clustering analysis was conducted. Four parameters explained the clustering categorization according to a multinomial regression (right ventricular (RV) end-diastolic mid-cavity diameter, RV free-wall strain, right atrial (RA) volume index, RA strain; p = 0.0039). Three clusters were identified in the retrospective cohort: Cluster 1 had better right ventricular, left ventricular, and right atrial function than Cluster 2 (reduced RV and RA strain despite similar sizes). Cluster 3 included patients with severely dilated heart chambers associated to RV and RA dysfunctions. When applying the model in the validation (external) cohort, the rate of the primary endpoint (hospitalization for heart failure and/or death from any cause) was lowest in Cluster 1 (30.8% versus 48% and 58.8% in Clusters 2 and 3, respectively; p < 0.05). CONCLUSION In FTR patients, different profiles of RV and RA remodeling are associated with different outcomes. Therefore, the diagnostic work-up in this clinical setting should include RV and RA characteristics. Under noninterventional management, the phenotype corresponding to preserved RV size and preserved RA and RV functions appears to have a better prognosis.
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Affiliation(s)
- Mathilde Vely
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Guillaume L'official
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Wojciech Kosmala
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Anne Guerin
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Elisabeth Chen
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | | | | | - Emmanuel Oger
- EA Reperes, CHU Rennes, University Rennes, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
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11
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Freixa X, Arzamendi D, del Trigo M, Cepas-Guillén PL, Li P, Sanchis L, Barreiro M, Regueiro A, Baz JA, Asmarats L, Calvo F, Moñivas V, Meduiña I, Goicolea J, Sitges M, Estévez-Loureiro R. El sistema TriClip para la reparación transcatéter de la válvula tricúspide. Estudio multicéntrico español. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Zern EK, Wang D, Rambarat P, Bernard S, Paniagua SM, Liu EE, McNeill J, Wang JK, Andrews CT, Pomerantsev EV, Picard MH, Ho JE. Association of Pulmonary Artery Pulsatility Index With Adverse Cardiovascular Events Across a Hospital-Based Sample. Circ Heart Fail 2022; 15:e009085. [PMID: 35135302 PMCID: PMC8855684 DOI: 10.1161/circheartfailure.121.009085] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pulmonary artery pulsatility index (PAPi), calculated from the ratio of the pulmonary artery pulse pressure to right atrial pressure, is a predictor of right ventricular failure after inferior myocardial infarction and left ventricular assist device implantation. Whether PAPi is associated with adverse outcomes across a heterogeneous population is unknown. METHODS We examined consecutive patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort. Multivariable Cox models were utilized to examine the association between PAPi and all-cause mortality, major adverse cardiac events, and heart failure hospitalizations. RESULTS We studied 8285 individuals (mean age 63 years, 39% women) with median PAPi across quartiles 1.7, 2.8, 4.2, and 8.7, who were followed over a mean follow-up of 6.7±3.3 years. Patients in the lowest PAPi quartile had a 60% greater risk of death compared with the highest quartile (multivariable-adjusted hazard ratio, 1.60 [95% CI, 1.36-1.88], P<0.001) and a higher risk of major adverse cardiac events and heart failure hospitalizations (hazard ratio, 1.80 [95% CI, 1.56-2.07], P<0.001 and hazard ratio, 2.08 [95% CI, 1.76-2.47], P<0.001, respectively). Of note, patients in quartiles 2 and 3 also had increased risk of cardiovascular events compared with quartile 4 (multivariable P<0.05 for all). CONCLUSIONS Compared with the highest PAPi quartile, patients in PAPi quartiles 1 to 3 had a greater risk of all-cause mortality, major adverse cardiac events, and heart failure hospitalizations, with greatest risk observed in the lowest quartile. A low PAPi, even at values higher than previously reported, may serve an important role in identifying high-risk individuals across a broad spectrum of cardiovascular disease.
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Affiliation(s)
- Emily K. Zern
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Paula Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Samuel Bernard
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine
| | - Samantha M. Paniagua
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Elizabeth E. Liu
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jenna McNeill
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA
| | - Jessica K. Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carl T. Andrews
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Eugene V. Pomerantsev
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Michael H. Picard
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Jennifer E. Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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13
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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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14
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Donal E, Leurent G, Ganivet A, Lurz P, Coisne A, De Groote P, Lafitte S, Leroux L, Karam N, Biere L, Rouleau F, Sportouch C, Dreyfus J, Nejjari M, Josselin JM, Anselmi A, Galli E, Bajeux E, Guerin P, Obadia JF, Trochu JN, Oger E. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging 2021; 23:1617-1627. [PMID: 34871375 DOI: 10.1093/ehjci/jeab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. METHODS AND RESULTS The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. CONCLUSION Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.
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Affiliation(s)
- Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | | | - Anne Ganivet
- Direction for Research and Innovation, CHU Rennes, Rennes, France
| | - Philip Lurz
- Heart Center at University of Leipzig, Leipzig, Germany
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | - Pascal De Groote
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | | | - Lionel Leroux
- CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicole Karam
- University of Paris, Medico-Surgical Heart Valve Unit, European Hospital Georges-Pompidou, INSERM, U970 Paris, France
| | - Loic Biere
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | - Frederic Rouleau
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | | | | | | | | | - Amedeo Anselmi
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Emma Bajeux
- INSERM1085, IRSET, University Rennes, CHU Rennes, Rennes, France
| | - Patrice Guerin
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Cardiologic CHU Lyon, University Lyon, Lyon, France
| | - Jean-Noel Trochu
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University Rennes, Rennes, France
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15
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Lancellotti P, Go Y, Vannan MA. The value of cardiac output measurement in tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2021; 22:886-887. [PMID: 34151930 DOI: 10.1093/ehjci/jeab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Via C. Rosalba, 35/37 - 70124 Bari, Italy
| | - YunYun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Mani A Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, 95 Collier Road, Atlanta, GA 30305, USA
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16
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Unterhuber M, Kresoja KP, Besler C, Rommel KP, Orban M, von Roeder M, Braun D, Stolz L, Massberg S, Trebicka J, Zachäus M, Hausleiter J, Thiele H, Lurz P. Cardiac output states in patients with severe functional tricuspid regurgitation: impact on treatment success and prognosis. Eur J Heart Fail 2021; 23:1784-1794. [PMID: 34272792 DOI: 10.1002/ejhf.2307] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS To investigate whether there is evidence for distinct cardiac output (CO) based phenotypes in patients with chronic right heart failure associated with severe tricuspid regurgitation (TR) and to characterize their impact on TR treatment and outcome. METHODS AND RESULTS A total of 132 patients underwent isolated transcatheter tricuspid valve repair (TTVR) for functional TR at two centres. Patients were clustered according to k-means clustering into low [cardiac index (CI) < 1.7 L/min/m2 ], intermediate (CI 1.7-2.6 L/min/m2 ) and high CO (CI > 2.6 L/min/m2 ) clusters. All-cause mortality and clinical characteristics during follow-up were compared among different CO clusters. Mortality rates were highest for patients in a low (24%) and high CO state (42%, log-rank P < 0.001). High CO state patients were characterized by larger inferior vena cava diameters (P = 0.003), reduced liver function, higher incidence of ascites (P = 0.006) and markedly reduced systemic vascular resistance (P < 0.001) as compared to TTVR patients in other CO states. Despite comparable procedural success rates, the extent of changes in right atrial pressures (P = 0.01) and right ventricular dimensions (P < 0.001) per decrease in regurgitant volume following TTVR was less pronounced in high CO state patients as compared to other CO states. Successful TTVR was associated with the smallest prognostic benefit among low and high CO state patients. CONCLUSIONS Patients with chronic right heart failure and severe TR display distinct CO states. The high CO state is characterized by advanced congestive hepatopathy, a substantial decrease in peripheral vascular tone, a lack of response of central venous pressures to TR reduction, and worse prognosis. These data are relevant to the pathophysiological understanding and management of this important clinical syndrome.
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Affiliation(s)
- Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - Markus Zachäus
- Department of Gastroenterology, Hepatology, Hematology and Oncology, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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