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Bohbot Y, Tordjman L, Dreyfus J, Le Tourneau T, Lavie-Badie Y, Selton-Suty C, Elegamandji B, L’official G, Fraix A, Aghezzaf S, Turgeon PY, Messika Zeitoun D, Enriquez-Sarano M, Coisne A, Donal E, Tribouilloy C. Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk. Front Cardiovasc Med 2023; 10:1090572. [PMID: 37180795 PMCID: PMC10172668 DOI: 10.3389/fcvm.2023.1090572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes. Materials and methods In this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm2) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality. Results The relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA <60 mm2 vs. ≥60 mm2 (68 ± 3% vs. 64 ± 5%, p = 0.89). A TCG ≥10 mm was associated with lower four-year survival than a TCG <10 mm (53 ± 7% vs. 69 ± 3%, p < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95% CI] = 1.47[1.13-2.21], p = 0.019) and cardiovascular mortality (adjusted HR[95% CI] = 2.12[1.33-3.25], p = 0.001), whereas an EROA ≥60 mm2 was not associated with all-cause or cardiovascular mortality (adjusted HR[95% CI]: 1.16[0.81-1.64], p = 0.416, and adjusted HR[95% CI]: 1.07[0.68-1.68], p = 0.784, respectively). Conclusion The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated significant functional TR.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Léa Tordjman
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | | | | | - Antoine Fraix
- Cardiology Department CIC-EC, CHU Nancy-Brabois, Nancy, France
| | - Samy Aghezzaf
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
| | | | | | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Augustin Coisne
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011—EGID, University Lille, Lille, France
- Cardiovascular Research Foundation, New York, NY, United States
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI—UMR 1099, University of Rennes, Rennes, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Correspondence: Christophe Tribouilloy
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Elegamandji B, Alamowitch S, Crozier S, Sabben C, Deltour S, Obadia M, Benyounes N, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure. JACC Cardiovasc Interv 2022; 15:2315-2322. [PMID: 36008269 DOI: 10.1016/j.jcin.2022.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patient-reported symptomatic episodes, so the true incidence and timing of AF after PFO closure remain unknown. OBJECTIVES The aim of this study was to prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure on the basis of loop recorder monitoring. METHODS Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 at a single center by means of implantable loop recorder monitoring in patients considered at higher risk for AF (age ≥ 55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder monitoring in other patients. The primary endpoint was the incidence of AF, atrial flutter, or supraventricular tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed using a stepwise logistic regression model. RESULTS A total of 225 patients were included. The primary endpoint occurred in 47 patients (20.9%), including 13 (9.9%) and 24 (28.9%) among patients monitored with external loop recorders and implantable loop recorders, respectively. Overall, the median delay from procedure to arrhythmia was 14.0 days (IQR: 6.5-19.0 days), and one-half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted OR: 1.67 per 10-year increase; 95% CI: 1.18-2.36), device left disc diameter ≥25 mm (adjusted OR: 2.67; 95% CI: 1.19-5.98) and male sex (adjusted OR: 4.78; 95% CI: 1.96-11.66). CONCLUSIONS Using loop recorder monitoring for ≥28 days, supraventricular arrhythmia was diagnosed in 1 in 5 patients, with a median delay of 14 days, suggesting that this postprocedural event has so far been underestimated.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Marie Hauguel-Moreau
- INSERM U-1018, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Thomas Wallet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Benjamin Elegamandji
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Sonia Alamowitch
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Sophie Crozier
- Sorbonne Université, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Candice Sabben
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Sandrine Deltour
- Neurology Department, Raymond-Poincaré Hospital (AP-HP), Garches, France
| | - Michaël Obadia
- Rothschild Foundation Hospital, Neurology Department, Paris, France
| | - Nadia Benyounes
- Cardiology Department, Rothschild Foundation Hospital, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France.
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Mertens E, Hekimian G, Leprince P, Elegamandji B, Redheuil A, Bouziri N, Isnard R, Montalescot G, Hammoudi N. Prosthesis choice for surgical treatment of left-sided native valve infective endocarditis: Determinants and impact on outcomes. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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