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Papadopoulos CH, Kadoglou NPE, Theodosis-Georgilas A, Papadopoulos KG, Rallidis L, Loizos S, Karabinos I, Kassinos N, Sahpekidis V, Chrysoheris M, Ninios V, Frogoudaki A, Makavos G, Drakopoulou M, Yiangou K, Karagiannis S, Zois N, Patrianakos A, Ikonomidis I, Tsiapras D, Kouris N, Aggeli K, Pappas K, Prappa E, Stefanidis A. Practical guidance and clinical applications of transoesophageal echocardiography. A position paper of the working group of echocardiography of the Hellenic Society of Cardiology. Curr Probl Cardiol 2024; 49:102634. [PMID: 38734120 DOI: 10.1016/j.cpcardiol.2024.102634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Transoesophageal echocardiography (TOE) is a well-established imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for a wide spectrum cardiac and extra-cardiac diseases. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Cardiology Society to state the essential steps of the typical TOE exam performed in echo lab. This is an educational text, describing the minimal requirements and the preparation of a meticulous TOE examination. Most importantly, it gives practical instructions to obtain and optimize TOE views and analyses the implementation of a combined two-and multi-dimensional protocol for the imaging of the most common cardiac structures during a TOE. In the second part of the article a comprehensive review of the contemporary use of TOE in a wide spectrum of valvular and non-valvular cardiac diseases is provided, based on the current guidelines and the experience of the WG members.
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Affiliation(s)
- Constantinos H Papadopoulos
- 2nd Cardiology Department, Korgialenio - Benakio Red Cross Hospital, +10 Platonos street, Neo Psychiko, Athens 15451, Greece.
| | | | | | | | | | | | | | | | | | | | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | | | - Maria Drakopoulou
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | | | - Nikolaos Zois
- Private Practice, Cardiology Department, University Hospital of Ioannina, Greece
| | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | - Efstathia Prappa
- Cardiology Department, General Hospital of Evaggelismos, Athens, Greece
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Crossley GH, Kowal J. Editorial: Cardiac implantable electronic device-induced tricuspid regurgitation: Implications and management. J Cardiovasc Electrophysiol 2024; 35:1217-1218. [PMID: 38600672 DOI: 10.1111/jce.16271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024]
Affiliation(s)
- George H Crossley
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jamie Kowal
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Escabia C, Bayes-Genis A, Delgado V. Three-Dimensional Echocardiography for Tricuspid Valve Assessment. Curr Cardiol Rep 2022; 24:1611-1618. [PMID: 36048305 DOI: 10.1007/s11886-022-01780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This review article provides an overview of the various roles of 3-dimensional (3D) echocardiography in the evaluation of the tricuspid valve (TV) with specific focus on tricuspid regurgitation (TR) and its treatment. RECENT FINDINGS The prognostic implications of TR and the advent of new transcatheter therapies have underscored the need of accurate assessment of the TV. 3D echocardiography is key to assess the anatomy and function of TV and has provided new insights that have led to new classifications of the type of TR. Furthermore, 3D echocardiography is superior to 2-dimensional echocardiography to assess the right ventricle, an important parameter to select the patients with severe TR who may benefit from intervention. Finally, the use of 3D echocardiography during the guidance of transcatheter interventions is pivotal to ensure procedural success and minimize the complications. Three-dimensional echocardiography provides the soft tissue resolution that fluoroscopy does not provide.
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Affiliation(s)
- Claudia Escabia
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain
| | - Antoni Bayes-Genis
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain. .,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Tadic M, Cuspidi C, Morris DA, Rottbauer W. Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure? Heart Fail Rev 2022; 27:1301-1312. [PMID: 34264478 PMCID: PMC9197807 DOI: 10.1007/s10741-021-10141-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany.
| | | | - Daniel Armando Morris
- Department of Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Wolfang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany
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Ricci F, Bufano G, Galusko V, Sekar B, Benedetto U, Awad WI, Di Mauro M, Gallina S, Ionescu A, Badano L, Khanji MY. Tricuspid regurgitation management: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:238-248. [PMID: 34878111 DOI: 10.1093/ehjqcco/qcab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent condition and an independent risk factor for adverse outcomes. Multiple clinical guidelines exist for the diagnosis and management of TR, but the recommendations may sometimes vary. We systematically reviewed high-quality guidelines with a specific focus on areas of agreement, disagreement, and gaps in evidence. We searched MEDLINE and EMBASE (1 January 2011 to 30 August 2021), the Guidelines International Network International, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed (as assessed by the Appraisal of Guidelines for Research and Evaluation II tool). Three guidelines were finally retained. There was consensus on a TR grading system, recognition of isolated functional TR associated with atrial fibrillation, and indications for valve surgery in symptomatic vs. asymptomatic patients, primary vs. secondary TR, and isolated TR forms. Discrepancies exist in the role of biomarkers, complementary multimodality imaging, exercise echocardiography, and cardiopulmonary exercise testing for risk stratification and clinical decision-making of progressive TR and asymptomatic severe TR, management of atrial functional TR, and choice of transcatheter tricuspid valve intervention (TTVI). Risk-based thresholds for quantitative TR grading, robust risk score models for TR surgery, surveillance intervals, population-based screening programmes, TTVI indications, and consensus on endpoint definitions are lacking.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströmsgata 35-205, 22100 Malmö, Sweden
- Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Gabriella Bufano
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Baskar Sekar
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Michele Di Mauro
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
- Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Mohammed Y Khanji
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, 6229 HX, Maastricht, the Netherlands
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
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Singulane CC, Singh A, Addetia K, Yamat M, Lang RM. Developing Insights Regarding Tricuspid Valve Regurgitation: Morphology, Assessment of Severity, and the Need for a Novel Grading Scheme. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100026. [PMID: 37273466 PMCID: PMC10236825 DOI: 10.1016/j.shj.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/17/2022] [Indexed: 06/06/2023]
Abstract
Current understanding that progressive tricuspid regurgitation (TR) is associated with worse outcomes has highlighted the clinical need for a more accurate assessment of TR morphology and severity. This need has been further emphasized owing to the development of a myriad of percutaneous right-sided interventions, which may offer successful treatment of TR in selected patients. Understanding the etiology and quantification of the severity of TR has important implications in the selection of novel therapeutic strategies, i.e., medical vs. percutaneous vs. surgical approaches. Newer grading schemas that better reflect the TR lesion severity have been recently proposed and may facilitate monitoring of the evolution of TR following percutaneous and/or surgical treatment. In this review, we summarize contemporary concepts regarding tricuspid valve morphology, TR etiology, and associated mechanisms and echocardiographic approaches to grade TR severity.
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Affiliation(s)
| | | | | | | | - Roberto Miguel Lang
- Address correspondence to: Roberto Miguel Lang, MD, FASE, FACC, The University of Chicago Medicine, 5758 S. Maryland Avenue, MR 9067, DCAM 5509, Chicago, IL 6063
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