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Tat E, Hamid N, Khalique O, Lehenbauer K, Sitticharoenchai P, Nazif T, Vahl T, Ng V, George I, Cahill T, Blusztein D, Mihatov N, Leon M, Kodali SK, Hahn RT. Impact of regurgitant orifice ellipticity on quantitation of tricuspid regurgitation using the proximal isovelocity surface area method. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.375] [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
Funding Acknowledgements
Type of funding sources: None.
Background
The proximal isovelocity surface area (PISA) method to quantify tricuspid regurgitation (TR) severity relies on the geometric assumption of a circular, planar regurgitant orifice. However, the TR orifice is often non-circular resulting in underestimation of TR severity when calculating the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol).
Purpose
To evaluate the effect of ellipticity of the tricuspid annulus on EROA-PISA correlation with quantitative Doppler (EROA-Dopp), and three-dimensional vena contracta area (VCA-3D).
Methods
Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echo evaluation of TR severity were included in this study. Regurgitant orifice ellipticity was calculated as the ratio of the vena contracta maximum and minimum widths (VC-Ratio). Quantification of EROA and RegVol were performed on TTE for EROA-PISA and EROA-Dopp. Vena contract area was measured on TEE (VCA-3D).
Results
Of 44 total pts, the median age was 80 ± 9, 61% were female, 89% had atrial fibrillation, (86%) had functional TR, 32% were graded as severe, and 71% had a EROA-PISA ≥ 0.4 cm2. Median VC-Ratio was 1.3 (IQR 1.1-1.8) and was used to differentiate more circular orifices (VC-Ratio <1.3) from more elliptical orifices (VC-Ratio ≥1.3) (Table). EROA-PISA was significantly smaller compared to EROA-Dopp and VCA-3D in the whole group as well as elliptical subgroups (p < 0.0001 for all). There was no significant difference between EROA-Dopp and 3D-VCA for the whole group, or in circular or elliptical orifice subgroups (p > 0.5 for all). EROA-PISA correlated better with both EROA-Dopp and VCA-3D in circular compared to elliptical orifices (Table). EROA-Dopp and VCA-3D demonstrated high correlation for both circular and elliptical orifices (r = 0.76, p < 0.0001 and r = 0.77, p < 0.0001 respectively).
Conclusion
Our study demonstrated that there is a significant difference in quantitative measurements of tricuspid regurgitant orifice area, with EROA-PISA significantly underestimating both EROA-Dopp and VCA-3D. In more circular orifices, the EROA-PISA correlation was higher, however EROA-Dopp and VCA-3D were still significantly larger. Whether EROA-Dopp and VCA-3D are more predictive of outcomes requires further study. Abstract Table 1 Abstract Figure 1
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Affiliation(s)
- E Tat
- Columbia University Medical Center, New York, United States of America
| | - N Hamid
- Columbia University Medical Center, New York, United States of America
| | - O Khalique
- Columbia University Medical Center, New York, United States of America
| | - K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | | | - T Nazif
- Columbia University Medical Center, New York, United States of America
| | - T Vahl
- Columbia University Medical Center, New York, United States of America
| | - V Ng
- Columbia University Medical Center, New York, United States of America
| | - I George
- Columbia University Medical Center, New York, United States of America
| | - T Cahill
- Columbia University Medical Center, New York, United States of America
| | - D Blusztein
- Columbia University Medical Center, New York, United States of America
| | - N Mihatov
- Columbia University Medical Center, New York, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - SK Kodali
- Columbia University Medical Center, New York, United States of America
| | - RT Hahn
- Columbia University Medical Center, New York, United States of America
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Lehenbauer K, Asch F, Weissman NJ, Grayburn P, Kar S, Lim S, Li D, Puri R, Kapadia S, Sannino A, Lindenfeld J, Abraham W, Mack MJ, Stone GW, Hahn R. Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.206] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
Background
Prior studies suggest tricuspid regurgitation (TR) diminishes/resolves following mitral valve surgery and thus do not require treatment and may not influence outcomes.
Purpose
We sought to evaluate the change in TR (ΔTR) and its association with outcomes after transcatheter edge-to-edge repair (TEER) compared with guideline-directed medical therapy (GDMT) in the COAPT trial.
Methods
Patients from the COAPT trial with echo core lab TR assessment at baseline and 30-day follow-up (n = 504) were included and divided into 2 groups: those whose TR worsened (ΔTR-INC) and those with no change or improvement in TR (ΔTR-SAME/DEC). Two-year composite endpoints of death or heart failure hospitalization (HFH) and the individual components were analyzed, after excluding events occurring within the first 30 days.
Results
ΔTR-SAME/DEC occurred in 430 pts (228 TEER, 202 GDMT) while ΔTR-INC was noted in 74 pts (38 TEER, 36 GDMT) (Figure 1A). From 30 days to 2 years, ΔTR-INC pts had a higher rate of the composite outcome of death or HFH compared with ΔTR-SAME/DEC (p = 0.006, Figure 1B). Both 2-year death (HR 1.52, 95% CI 1.01-2.27; p = 0.04) and HFH (HR 1.52, 95% CI 1.04-2.22; p = 0.03) were associated with ΔTR-INC. Assessed by treatment group (Figure 1C and 1D), the relationship between ΔTR-INC and composite death or HFH was significant in GDMT alone pts (HR 1.86, 95% CI 1.21-2.86) but not in TEER pts (HR 1.33, 95% CI 0.79-2.23), although interaction testing demonstrated consistency between the two treatments (Pint = 0.31).
Conclusions
Worsening TR at 30 days occurred in ∼15% of pts in the COAPT trial whether they were treated with TEER or GDMT alone. DTRINC was associated with increased death and HFH during 2-year follow-up. Abstract Figure 1
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Affiliation(s)
- K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | - F Asch
- Medstar Research Institute, Washington, DC, United States of America
| | - NJ Weissman
- Medstar Research Institute, Washington, DC, United States of America
| | - P Grayburn
- Baylor Scott & White Health, Plano, United States of America
| | - S Kar
- Los Robles Health System, Los Angeles, United States of America
| | - S Lim
- University of Virginia, Charlottesville, United States of America
| | - D Li
- Cardiovascular Research Foundation, New York, United States of America
| | - R Puri
- Cleveland Clinic, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic, Cleveland, United States of America
| | - A Sannino
- Baylor Scott & White Health, Plano, United States of America
| | - J Lindenfeld
- Vanderbilt University Medical Center, Nashville, United States of America
| | - W Abraham
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - MJ Mack
- Baylor Scott & White Health, Plano, United States of America
| | - GW Stone
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Hahn
- Columbia University Medical Center, New York, United States of America
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Tat E, Hamid N, Khalique O, Lehenbauer K, Sitticharoenchai P, Nazif T, Vahl T, Ng V, George I, Cahill T, Blusztein D, Mihatov N, Leon M, Kodali SK, Hahn RT. Correlation between standard and adjusted echocardiographic quantitative methods for evaluating tricuspid regurgitation severity. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.369] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Current guidelines advocate for a multi-parametric approach to echocardiographic quantitation of tricuspid regurgitation (TR). The primary quantitative measure of TR severity uses the proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). However, EROA-PISA may underestimate TR severity due to low flow and tethering of the tricuspid leaflets.
Purpose
The purpose of this study was to compare standard EROA-PISA quantitation of TR to alternative quantitative measures, including quantitative Doppler (EROA-Doppler), flow- and angle-corrected PISA method (EROA-Corrected), and three-dimensional vena contracta area (3D-VCA), in addition to the comparison of calculated RegVol-PISA, RegVol-Doppler, and RegVol-3DVCA.
Methods
Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echocardiographic evaluation of TR severity for transcatheter treatment were included in this study. Patients were excluded if they had ≥ moderate aortic regurgitation. TTE measurements of EROA-PISA and RegVol-PISA were performed as per American Society of Echocardiography guidelines. EROA-Doppler was performed by quantifying RegVol-Doppler (diastolic stroke volume using biplane annular area, minus left ventricular outflow stroke volume) and deriving EROA. EROA-Corrected was calculated by adjusting for both aliasing velocity and leaflet angle as per published methods. 3D-VCA was measured on TEE performed within 14 days of TTE.
Results
Of 44 consecutive patients, the median age was 80 ± 9 years, 61% were female, and 89% had atrial fibrillation. Most patients (86%) had functional TR, 71% had a EROA-PISA ≥ 0.4 cm2. Table 1 shows the EROA and RegVol results for each method. EROA-PISA and RegVol-PISA were significantly lower than EROA-Doppler and RegVol-Doppler, as well as 3D-VCA and RegVol-3DVCA (all p < 0.0001). There was no significant difference between EROA-Doppler and 3D-VCA (p = 0.51), and RegVol-Doppler and RegVol-3DVCA (p = 0.66). EROA-Corrected reduced the absolute difference with EROA-Doppler (51% to 33%, p < 0.0001) and 3D-VCA (52% to 32%, p < 0.0001), but remained statistically lower than EROA-Doppler and 3D-VCA. Although EROA-PISA was strongly correlated to EROA-Doppler (r = 0.75, p < 0.0001) and 3D-VCA (r = 0.68, p < 0.0001), the correlation between EROA-Doppler and 3D-VCA was greatest (r = 0.77, p < 0.0001). Adjusting EROA-PISA for angle and flow demonstrated improved correlation to EROA-Doppler without affecting correlation to 3D-VCA (Figure 1).
Conclusion
Our study demonstrated that EROA-PISA significantly underestimates the severity of TR by EROA-Doppler and 3D-VCA. Although PISA correction methods reduced the underestimation, both EROA-Corrected and RegVol-Corrected remained significantly lower. EROA-Doppler and 3D-VCA and the calculated RegVol by each method, were closely correlated and not significantly different. Abstract Table 1 Abstract Figure 1
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Affiliation(s)
- E Tat
- Columbia University Medical Center, New York, United States of America
| | - N Hamid
- Columbia University Medical Center, New York, United States of America
| | - O Khalique
- Columbia University Medical Center, New York, United States of America
| | - K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | | | - T Nazif
- Columbia University Medical Center, New York, United States of America
| | - T Vahl
- Columbia University Medical Center, New York, United States of America
| | - V Ng
- Columbia University Medical Center, New York, United States of America
| | - I George
- Columbia University Medical Center, New York, United States of America
| | - T Cahill
- Columbia University Medical Center, New York, United States of America
| | - D Blusztein
- Columbia University Medical Center, New York, United States of America
| | - N Mihatov
- Columbia University Medical Center, New York, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - SK Kodali
- Columbia University Medical Center, New York, United States of America
| | - RT Hahn
- Columbia University Medical Center, New York, United States of America
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Lehenbauer K, Qarajeh R, Shatla I, Singh A, Patel K, Peri-Okonny P, Kennedy K, Torres N, Myadam R, Sperry B, Saeed I, Thompson R, McGhie A, Bateman T. Multimodality Imaging: Coronary Calcium Scoring And Myocardial Blood Flow Reserve To Predict Underlying Multivessel Coronary Artery Disease. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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