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Cersosimo A, Gavazzoni M, Inciardi RM, Radulescu CI, Adamo M, Arabia G, Metra M, Raddino R, Vizzardi E. Right ventricle assessment before tricuspid valve interventions. J Cardiovasc Med (Hagerstown) 2024; 25:95-103. [PMID: 38149699 PMCID: PMC10906196 DOI: 10.2459/jcm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 12/28/2023]
Abstract
In the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions.
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Affiliation(s)
- Angelica Cersosimo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Mara Gavazzoni
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Riccardo Maria Inciardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Crina Ioana Radulescu
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Gianmarco Arabia
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Riccardo Raddino
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
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Venkataramani R, Hershberger A, Choi CH, Ng V, Bhardwaj A, Ramakrishna H. Tricuspid Regurgitation: A Focus on Updated Interventional Anatomy and Pathophysiology. J Cardiothorac Vasc Anesth 2023; 37:2327-2334. [PMID: 37573214 DOI: 10.1053/j.jvca.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Ranjani Venkataramani
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Amy Hershberger
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Christine Heejae Choi
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Victor Ng
- Department of Anesthesiology and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Adarsh Bhardwaj
- Department of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Harish Ramakrishna
- Department of Cardiology, University of California, San Francisco, San Francisco, CA.
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Eleid MF, Nkomo VT, Pislaru SV, Gersh BJ. Valvular Heart Disease: New Concepts in Pathophysiology and Therapeutic Approaches. Annu Rev Med 2023; 74:155-170. [PMID: 36400067 DOI: 10.1146/annurev-med-042921-122533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
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4
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Clinical Predictors of Mortality and Heart Failure Hospitalization in Patients With Severe Tricuspid Regurgitation. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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5
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Analysis of Cardiac Computed Tomography Anatomy in Patients With Severe Tricuspid Regurgitation Considered for Transcatheter Intervention. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Lara-Breitinger KM, Scott CG, Nkomo VT, Pellikka PA, Kane GC, Chaliki HP, Shapiro BP, Eleid MF, Alkhouli M, Greason KL, Pislaru SV, Rihal CS. Tricuspid Regurgitation Impact on Outcomes (TRIO): A Simple Clinical Risk Score. Mayo Clin Proc 2022; 97:1449-1461. [PMID: 35933133 DOI: 10.1016/j.mayocp.2022.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/20/2022] [Accepted: 05/03/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine which clinical variables infer the highest risk for mortality in patients with notable tricuspid regurgitation (TR) and to develop a clinical assessment tool (the Tricuspid Regurgitation Impact on Outcomes [TRIO] score). PATIENTS AND METHODS A single-center retrospective cohort of 13,608 patients with undifferentiated moderate to severe TR at the time of index echocardiography between January 1, 2005, and December 31, 2016, was included. Baseline demographic and clinical data were obtained. Patients were randomly assigned to a training (N=10,205) and a validation (N=3403) cohort. Median follow-up was 6.5 years (interquartile range, 0.8 to 11.0 years). Variables associated with mortality were identified by Cox proportional hazards methods. A geographically distinct cohort of 7138 patients was used for further validation. The primary end point was all-cause mortality over 10 years. RESULTS The 5-year probability of death was 53% for moderate TR, 63% for moderate-severe TR (hazard ratio [HR], 1.24 [95% CI, 1.17 to 1.31]; P<.001 vs moderate), and 71% for severe TR (HR, 1.55 [95% CI, 1.47 to 1.64]; P<.001 vs moderate). Factors associated with all-cause mortality on multivariate analysis included age 70 years or older, male sex, creatinine level greater than 2 mg/dL, congestive heart failure, chronic lung disease, aspartate aminotransferase level of 40 U/L or greater, heart rate of 90 beats/min or greater, and severe TR. Variables were assigned 1 or 2 points (HR, >1.5) and added to compute the TRIO score. The score was associated with all-cause mortality (C statistic = 0.67) and was able to separate patients into risk categories. Findings were similar in the second, independent and geographically distinct cohort. CONCLUSION The TRIO score is a simple clinical tool for risk assessment in patients with notable TR. Future prospective studies to validate its use are warranted.
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Affiliation(s)
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hari P Chaliki
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ
| | - Brian P Shapiro
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Chen S, Chen L, Saguner AM, Chen K, Akdis D, Gasperetti A, Brunckhorst C, Tang H, Guo G, Rao M, Li X, Song J, Duru F, Hu S. Novel Risk Prediction Model to Determine Adverse Heart Failure Outcomes in Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Heart Assoc 2022; 11:e024634. [PMID: 35766284 PMCID: PMC9333366 DOI: 10.1161/jaha.121.024634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patients with arrhythmogenic right ventricular cardiomyopathy are at risk for life‐threatening ventricular tachyarrhythmias, but progressive heart failure (HF) may occur in later stages of disease. This study aimed to characterize potential risk predictors and develop a model for individualized assessment of adverse HF outcomes in arrhythmogenic right ventricular cardiomyopathy. Methods and Results Longitudinal and observational cohorts with 290 patients with arrhythmogenic right ventricular cardiomyopathy from the Fuwai Hospital in Beijing, China, and 99 patients from the University Heart Center in Zurich, Switzerland, with follow‐up data were studied. The primary end point of the study was heart transplantation or death attributable to HF. The model was developed by Cox regression analysis for predicting risk and was internally validated. During 4.92±3.03 years of follow‐up, 48 patients reached the primary end point. The determinants of the risk prediction model were left ventricular ejection fraction, serum creatinine levels, moderate‐to‐severe tricuspid regurgitation, and atrial fibrillation. Implantable cardioverter‐defibrillators did not reduce the occurrence of adverse HF outcomes. Conclusions A novel risk prediction model for arrhythmogenic right ventricular cardiomyopathy has been developed using 2 large and well‐established cohorts, incorporating common clinical parameters such as left ventricular ejection fraction, serum creatinine levels, tricuspid regurgitation, and atrial fibrillation, which can identify patients who are at risk for terminal HF events, and may guide physicians to assess individualized HF risk and to optimize management strategies.
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Affiliation(s)
- Shi Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | | | - Kai Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Deniz Akdis
- University Heart Center Zurich Zurich Switzerland
| | | | | | - Hanwei Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Guangran Guo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Man Rao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiangjie Li
- School of Statistics and Data Science Nankai University Tianjin China
| | - Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Firat Duru
- University Heart Center Zurich Zurich Switzerland.,Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Schipmann F, Bannehr M, Hähnel V, Dworok V, Nübel J, Edlinger C, Lichtenauer M, Haase M, Zänker M, Butter C, Haase-Fielitz A. Progression of Chronic Kidney Disease and All-Cause Mortality in Patients with Tricuspid Regurgitation. Diseases 2022; 10:16. [PMID: 35323183 PMCID: PMC8946925 DOI: 10.3390/diseases10010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023] Open
Abstract
Aim: The impact of chronic kidney disease (CKD) on patient-related outcomes in patients with tricuspid regurgitation (TR) is well known. However, the impact of the progression of CKD in patients with TR and potentially modifiable risk factors of progressing CKD is unknown. Methods: 444 consecutive adult patients with TR and CKD stage 1−4 admitted in an inpatient setting between January 2010 and December 2017 were included. During a median follow-up of two years, eGFR and survival status were collected. Independent risk factors for CKD progression and all-cause mortality were determined. Patient survival statuses were grouped according to different combinations of the presence or absence of CKD progression and the TR grade. Results: Progression of CKD (OR 2.38 (95% confidence interval 1.30−4.35), p = 0.005), the grade of TR (OR 2.38 (1.41−4.00), p = 0.001) and mitral regurgitation (OR 1.72 (1.20−2.46), p = 0.003) were independent risk factors for all-cause mortality. Haemoglobin at admission (OR 0.80 (0.65−0.99), p = 0.043) and the presence of type 2 diabetes (OR 1.67 (1.02−2.73), p = 0.042) were independent risk factors for CKD progression. The combination of the status of CKD progression and the TR grade showed a stepwise pattern for all-cause mortality (p < 0.001). Patients with CKD progression and TR grade 1 had comparable all-cause mortality with patients without CKD progression but with TR grade 2 or 3. Even in patients with TR grade 1, the risk for all-cause mortality doubled if CKD progression occurred (OR 2.49 (95% CI 1.38−4.47), p = 0.002). Conclusion: CKD progression appears to be a risk factor for all-cause mortality in patients with TR. Anaemia and diabetes are potential modifiers of CKD progression.
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Affiliation(s)
- Fabian Schipmann
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Valentin Hähnel
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Victoria Dworok
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Jonathan Nübel
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Michael Haase
- Medical Faculty, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany;
| | - Michael Zänker
- Department of Internal Medicine, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, 16321 Bernau bei Berlin, Germany;
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany; (F.S.); (M.B.); (V.H.); (V.D.); (J.N.); (C.E.); (C.B.)
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
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Impact of tolvaptan on improvement of tricuspid regurgitation and right ventricular dimension in patients with right-sided heart failure. Heart Vessels 2022; 37:1153-1161. [PMID: 35050407 DOI: 10.1007/s00380-021-02014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
Managing right-sided chronic heart failure (CHF) due to tricuspid regurgitation (TR) remains a clinical challenge. Tolvaptan (TLV), a vasopressin V2 receptor inhibitor, is effective in controlling decompensated HF. However, its effects on right-sided CHF caused by TR are unclear. We sought to clarify the effects of TLV in CHF patients complicated with TR. The cohort consisted of 33 CHF patients with moderate or severe TR and permanent atrial fibrillation, who required hospitalization for HF. We observed 19 patients treated with TLV plus conventional therapies (TLV group) and 14 patients with conventional therapies alone (conventional group). Clinical characteristics, echocardiographic parameters, and laboratory data were investigated. Baseline characteristics were similar between groups. In the TLV group, the severity of TR at admission was 73.7% moderate and 26.3% severe. In the conventional group, these percentages were 85.7% and 14.3%, respectively. During the follow-up, the severity of TR improved in the TLV group (trivial-mild: 52.6%; moderate: 36.8%; severe: 10.5%) (p < 0.01). However, it did not improve in the conventional group (trivial-mild: 21.4%; moderate: 50.0%; severe: 28.6%) (p = 0.08). The diameter of the tricuspid annulus (p < 0.01), basal (p = 0.02), and mid right ventricle (p = 0.04) was reduced at follow-up in the TLV group. Nevertheless, these parameters did not change in the conventional group. Serum creatinine levels were maintained (p = 0.74) in the TLV group, but deteriorated in the conventional group (p = 0.03). TLV reduced right ventricular dimensions and improved TR without deterioration of renal function. Thus, TLV may be a new drug for the treatment of CHF patients with TR.
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Hua K, Zhao R, Peng Z, Yang Y, Florian O, Mao B, Yang X. Early surgery can improve the outcomes of patients with severe tricuspid regurgitation undergoing tricuspid replacement. Cardiovasc Diagn Ther 2021; 11:1058-1066. [PMID: 34815956 DOI: 10.21037/cdt-21-311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
Background Tricuspid regurgitation (TR) usually remains asymptomatic for a long time, such that it is most often diagnosed at an advanced stage of right heart failure. The purpose of this study was to identify clinical characteristics and overall outcomes in patients with severe TR who received tricuspid valve replacement (TVR) at different clinical stages. Methods Between 1993 and 2018, 256 severe TR patients who received TVR alone or in combination with other procedures were assessed at Beijing Anzhen Hospital. Ninety-three patients underwent New York Heart Association (NYHA) class I/II operations (early surgery group), and the others underwent NYHA class III/IV operations. The primary outcome was in-hospital and long-term mortality. Clinical outcomes were evaluated by the Kaplan-Meier method and Cox regression models. Follow-up was conducted annually. Propensity score matching and overlap propensity score weighting were performed as sensitivity analyses. Results Postoperative complications, including low cardiac output (11.8% vs. 26.4%, P<0.001), renal failure (2.2% vs. 16.6%, P<0.001), and bleeding (3.2% vs. 11.7%, P=0.037), were significantly lower in the NYHA class I/II group than in the NYHA III/IV group. Patients in the NYHA class III/IV group had a significantly higher incidence of in-hospital mortality (18.4% vs. 5.4%, P<0.001) and long-term mortality (33.7% vs. 11.8%, P=0.006) after follow-up (median follow-up duration =63 months). The results indicated a consistently higher occurrence rate in the propensity score-matched cohort and overlap propensity score weighted analysis. Conclusions Consistent with the recent clinical trend to provide earlier and more aggressive TR intervention, our results indicate that surgery for severe TR patients should be considered before advanced heart failure develops, when patients are asymptomatic or mildly symptomatic (NYHA class I/II).
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Affiliation(s)
- Kun Hua
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Rui Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Peng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Yunxiao Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Osmanaj Florian
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Bin Mao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Xiubin Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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11
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Eleid MF, Alkhouli M, Thaden JJ, Zahr F, Chadderdon S, Guerrero M, Reeder GS, Rihal CS. Utility of Intracardiac Echocardiography in the Early Experience of Transcatheter Edge to Edge Tricuspid Valve Repair. Circ Cardiovasc Interv 2021; 14:e011118. [PMID: 34474586 DOI: 10.1161/circinterventions.121.011118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Firas Zahr
- Department of Cardiovascular Medicine, Oregon Health and Sciences University, Portland (F.Z., S.C.)
| | - Scott Chadderdon
- Department of Cardiovascular Medicine, Oregon Health and Sciences University, Portland (F.Z., S.C.)
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
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12
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Chorin E, Rozenbaum Z, Topilsky Y, Konigstein M, Ziv-Baran T, Richert E, Keren G, Banai S. Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging 2021; 21:157-165. [PMID: 31544933 DOI: 10.1093/ehjci/jez216] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/30/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is a frequent echocardiographic finding; however, its effect on outcome is unclear. The objectives of current study were to evaluate the impact of TR severity on heart failure hospitalization and mortality. METHODS AND RESULTS We retrospectively reviewed consecutive echocardiograms performed between 2011 and 2016 at the Tel-Aviv Medical Center. TR severity was determined using semi-quantitative approach including colour jet area, vena contracta width, density of continuous Doppler jet, hepatic vein flow pattern, trans-tricuspid inflow pattern, annular diameter, right ventricle, and right atrial size. Major comorbidities, re-admissions and all-cause mortality were extracted from the electronic health records. The final analysis included 33 305 patients with median follow-up period of 3.34 years (interquartile range 2.11-4.54). TR (≥mild) was present in 31% of our cohort. One-year mortality rates were 7.7% for patients with no/trivial TR, 16.8% for patients with mild TR, 29.5% for moderate TR, and 45.6% for patients with severe TR (P < 0.001). Univariate and multivariate analyses demonstrated a positive correlation between TR severity and overall mortality and rates of heart failure re-admission after adjustment for potential confounders. The proportional hazards method for overall mortality showed that patients with moderate [hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.02-1.3, P = 0.024] and severe TR (HR 1.43, 95% CI 1.08-1.88, P = 0.011) had a worse prognosis than those with no or minimal TR. CONCLUSIONS The presence of any degree of TR is associated with adverse clinical outcome. At least moderate TR is independently associated with increased mortality.
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Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Richert
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
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13
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Wunderlich NC, Landendinger M, Arnold M, Achenbach S, Swaans MJ, Siegel RJ, Ho SY. State-of-the-Art Review: Anatomical and Imaging Considerations During Transcatheter Tricuspid Valve Repair Using an Annuloplasty Approach. Front Cardiovasc Med 2021; 8:619605. [PMID: 33614749 PMCID: PMC7892591 DOI: 10.3389/fcvm.2021.619605] [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: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter techniques for the treatment of tricuspid regurgitation (TR) are being more frequently used and several new devices are in development. Since 90% of patients with TR have secondary TR, catheter based systems which reduce the dilated tricuspid annulus area are of particular interest. In order to perform an annuloplasty procedure effectively and safely, knowledge about the anatomy of the tricuspid valve apparatus and especially of the annulus in relation to the important neighboring structures such as the aortic root, the RCA, the electrical pathways and the CS is fundamental. In addition, comprehensive understanding of the device itself, the delivery system, its maneuverability and the individual procedural steps is required. Furthermore, the use of multi-modality imaging is important. For each step of the procedure the appropriate imaging modality as well as the optimal; imaging planes are crucial to provide the necessary information to best guide the individual procedural step.
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Affiliation(s)
| | - Melanie Landendinger
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Robert J Siegel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
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14
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Kawsara A, Alqahtani F, Nkomo VT, Eleid MF, Pislaru SV, Rihal CS, Nishimura RA, Schaff HV, Crestanello JA, Alkhouli M. Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery. J Am Heart Assoc 2021; 10:e018417. [PMID: 33399012 PMCID: PMC7955319 DOI: 10.1161/jaha.120.018417] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [P<0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [P<0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.
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Affiliation(s)
- Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Fahad Alqahtani
- Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Rick A Nishimura
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Juan A Crestanello
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
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15
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Immediate, early and mid-term outcomes following balloon mitral valvotomy in patients having severe rheumatic mitral stenosis with significant tricuspid regurgitation. Indian J Thorac Cardiovasc Surg 2020; 36:483-491. [PMID: 33061159 DOI: 10.1007/s12055-020-01012-0] [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: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
Background The study examined the influence of significant tricuspid regurgitation (TR) on the immediate, early and mid-term outcomes of patients with severe mitral stenosis (MS) undergoing balloon mitral valvotomy (BMV). Methods Among the 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, 114 had significant TR. After propensity score-matched analysis, the data of 93 patients with significant TR were compared with the data of 93 patients who had no significant TR at the baseline. Outcomes were assessed immediately, at 1 year (early) and at 5 years (mid-term) after BMV. Results Patients with significant TR presented more frequently with NYHA class III-IV status, atrial fibrillation (AF), severe pulmonary hypertension (PH), advanced mitral valve disease as assessed by echocardiographic score > 8, and with history of previous BMV. After propensity score-matched analysis, it was found that the immediate procedural success (54.8% vs. 58.1%, P = 0.650), immediate in-hospital events and prevalence of AF and heart failure at 1 year of follow-up were comparable between the two groups. At 5 years after BMV, the significant TR group had higher prevalence of heart failure and AF, greater attrition in mitral valve area (MVA) and higher pulmonary artery (PA) pressure. Conclusions Significant TR identifies a sicker patient population with MS. Even though patients with significant TR have comparable immediate and early outcomes after BMV, they have poor outcomes on mid-term follow-up. Longer follow-up with more patients is needed to assess survival aspect of TR on patients undergoing BMV and also to look at the need for interventions to address the significant TR, apart from the mitral valve interventions.
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16
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Mahowald MK, Pislaru SV, Reeder GS, Padang R, Michelena HI, Mankad SV, Maalouf JF, Guerrero M, Alkhouli M, Rihal CS, Eleid MF. Institutional learning experience for combined edge-to-edge tricuspid and mitral valve repair. Catheter Cardiovasc Interv 2020; 96:1323-1330. [PMID: 32180349 DOI: 10.1002/ccd.28856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 03/07/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcatheter edge-to-edge repair with MitraClip is only approved for treatment of mitral regurgitation but is increasingly used to treat concomitant tricuspid regurgitation (TR) due to its common coexistence and association with poor outcomes. This study aimed to describe the learning curve associated with the challenge of off-label treatment of concomitant TR. METHODS This is a retrospective review of initial and consecutive patients who underwent combined edge-to-edge repair of mitral and tricuspid valves (TVs) at our institution from August 2017 to October 2019. RESULTS Repair of both valves with MitraClip was performed in 22 patients (median age 81.5 years, 32% female). Mean procedure time was 176 ± 47 min; mean fluoroscopy time was 65 ± 24 min. Procedure duration in the first tertile was significantly longer (223 ± 13 min) than in the third tertile (143 ± 23 min, p = .0003). Median number of total clips placed per case was 3; in 15 patients (68%), the anterior and septal leaflets of the TV were clipped. The average changes in mean right atrial (RA) and left atrial (LA) pressures were -1.7 ± 2.5 mmHg (p = .0080) and -3.2 ± 4.6 mmHg (p = .0045), respectively. The average changes in RA and LA V-wave heights were -3.3 ± 4.0 mmHg (p = .0009) and -8.1 ± 9.9 mmHg (p = .038), respectively. There was a significant trend toward decreasing residual TR over the course of the series (p = .046). At 30 days, survival was 100% and mean NYHA class decreased from 2.8 to 1.8 (p < .0001). CONCLUSIONS Combined edge-to-edge tricuspid and mitral valve repair is safe and feasible. With experience, procedure duration and residual TR decreased.
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Affiliation(s)
- Madeline K Mahowald
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph F Maalouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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17
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Reddy YNV, Nishimura R. Intervening for tricuspid regurgitation: uncertainties in a heterogeneous syndrome. BRITISH HEART JOURNAL 2019; 105:1770-1772. [PMID: 31444269 DOI: 10.1136/heartjnl-2019-315624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick Nishimura
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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18
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Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
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19
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Donal E, Galli E, Bidaut A. Advocacy for more consideration of the secondary tricuspid regurgitation. Heart 2019; 105:1221-1222. [DOI: 10.1136/heartjnl-2019-315262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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