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Hinojar Baydes R, De Angelis V, Garcia-Martin A, Gonzalez-Gomez A, Sanroman M, Pascual M, Lorente A, Monteagudo J, Jimenez-Nacher J, Zamorano J, Fernandez-Golfin C. Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction
Purpose
This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function.
Methods
Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave ('S) and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. A combined endpoint of hospital admission due to heart failure or cardiovascular mortality was defined.
Results
A total of 100 patients were included (mean age was 76±10 years, 65% females, 84% in NYHA I/II, 86% functional TR). Mean values of RV function parameters are shown in the table. During a mean follow up of 24±10 months, 24% of the patients reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS (p<0.01). Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p>0.05 for all).
Conclusion
In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - V De Angelis
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | | | - M Sanroman
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - M Pascual
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - A Lorente
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - J.M Monteagudo
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | - J.L Zamorano
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
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Hinojar Baydes R, De Angelis V, Gonzalez-Gomez A, Garcia-Martin A, Monteagudo J, Pascual M, Lorente A, Jimenez-Nacher J, Zamorano J, Fernandez-Golfin C. Beyond effective regurgitant orifice in quantitative assessment of tricuspid regurgitation: impact on clinical outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quantification in tricuspid regurgitation has been poorly investigated. Recommended methods and thresholds are directly translated from mitral regurgitation; however, the anatomy, hemodynamics, and regurgitant orifice geometry are different in TR. Effective regurgitant orifice (ERO) calculation may be incorrect in very severe TR when right atrial and ventricular pressures could get equalized resulting in typically very low TR velocities.
Purpose
Our aim was to compare the prognostic value of different parameters for the evaluation of the tricuspid regurgitation (TR).
Methods
Consecutive patients with significant TR (≥ moderate echocardiographic grade) evaluated in the Heart Valve Clinic were included. TR severity was evaluated by TR radius, TR flow rate, ERO and TR regurgitant volume by PISA method and biplane vena contracta (VC) width using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.
Results
A total of 100 patients were included (mean age: 76±10 years, 65% females, 86% functional TR, 84% in NYHA I/II). During a mean follow up of 24±10 months 36% of the patients reached the combined end-point. Patients with events showed more severe TR independently of the parameter applied (table). In univariate analysis, TR radius, TR flow rate, ERO and TR regurgitant volume were predictors of the combined endpoint (p<0.05 for all). Among all parameters, TR flow rate was the strongest and independent predictor of outcomes in multivariate and ROC analysis (HR per 1 ml/seg 1.02 [1.003–1.026], p=0.01). A value of TR flow rate of 109 ml/sec reached the best accuracy to predicted poor outcomes (p<0.01).
Conclusion
Among different parameters to graduate TR severity, TR flow rate was the strongest predictor of outcomes. Since it does not include the TR velocity in the calculation, its incremental benefit may be related to very severe cases of TR. In this scenario, right atrial and ventricular pressures are equalized and TR velocity calculation is not longer possible. New grading schemes for TR may include this parameter in the classification.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - V De Angelis
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | | | - J.M Monteagudo
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - M Pascual
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - A Lorente
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | - J.L Zamorano
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
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Barderas M, Darde V, de la Cuesta F, Jimenez-Nacher J, Lopez-Bescos L, Tuñon J, Egido J, Vivanco F. PO23-765 CIRCULATING HUMAN MONOCYTES ON THE ACUTE CORONARY SYNDROME EXPRESS A CHARACTERISTIC PROTEOMIC PROFILE: EFFECT OF ATORVASTATIN IN THE PROTEOMIC PROFILE. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71775-0] [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: 12/01/2022]
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