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Wu J, Ling Y. A review regarding the article 'Impact of tricuspid regurgitation severity on mortality in pulmonary hypertension patients: A comprehensive analysis. Curr Probl Cardiol 2024; 49:102535. [PMID: 38521290 DOI: 10.1016/j.cpcardiol.2024.102535] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Pulmonary hypertension (PH) presents as a complex hemodynamic and pathophysiologic state present in many cardiovascular, respiratory, and systemic diseases. PH is considered to have a higher risk of cardiovascular events and mortality. The most common type of functional tricuspid regurgitation (TR) is associated with PH. Secondary TR, resulting not from intrinsic valvular pathology but from distortion of the valve apparatus due to right ventricular remodeling and dilation, is commonly seen in the setting of PH. It has been increasingly recognized as not merely a bystander but a significant contributor to the worsening of symptoms and decline in functional status. However, the extent to which TR impacts the clinical course and mortality in PH remains a subject of active investigation. The simultaneous presence of PH and secondary tricuspid regurgitation (STR) portends particularly poor outcomes. However, not all patients with PH develop significant TR, and the mechanisms and clinical implications underlying this phenomenon remain unclear. TR is a highly prevalent echocardiographic finding in the general population. Historically considered as the "forgotten valve disease" by clinicians and interventional cardiologists, TR has become a hot topic in cardiovascular interventions over recent years. If left untreated until severe, as often occurs, TR correlates with consistent morbidity and mortality, and a variety of surgical and percutaneous treatments have therefore been proposed. Mortality from isolated surgical repair of TR remains higher than that from surgery of any other valve insufficiency and a large number of patients are often deemed not eligible for surgical repair.
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Affiliation(s)
- Juan Wu
- Out-patient Department, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041, China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041, China.
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Tribouilloy C, Vanhaecke P, Dreyfus J, Le Tourneau T, Lavie-Badie Y, Selton-Suty C, Coisne A, Donal E, Enriquez-Sarano M, Bohbot Y. Natural History of Isolated Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033933. [PMID: 38700043 DOI: 10.1161/jaha.124.033933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France
- Unite de recherche Universite Picardie Jules Verne 7517, Jules Verne University of Picardie Amiens France
| | - Pierre Vanhaecke
- Department of Cardiology Amiens University Hospital Amiens France
| | - Julien Dreyfus
- Cardiology Department Centre Cardiologique du Nord Saint-Denis France
| | - Thierry Le Tourneau
- l'Institut du Thorax, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Université Nantes Nantes France
| | - Yoan Lavie-Badie
- Department of Cardiology Rangueil University Hospital Toulouse France
| | - Christine Selton-Suty
- Cardiology Department Centre d'Investigation Clinique - Epidémiologie Clinique Centre hospitalier universitaire Nancy-Brabois Nancy France
| | - Augustin Coisne
- University Lille, Inserm, Centre hospitalier universitaire Lille, Institut Pasteur de Lille, U1011-European Genomic Institute for Diabetes Lille France
- Cardiovascular Research Foundation New York NY
| | - Erwan Donal
- University of Rennes, Centre hospitalier universitaire Rennes, institut national de la santé et de la recherche médicale, Laboratoire du traitement et du signal de l'image-UMR 1099 Rennes France
| | | | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France
- Unite de recherche Universite Picardie Jules Verne 7517, Jules Verne University of Picardie Amiens France
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Plant A, Stewart F, Hooks D. Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation. J Cardiovasc Electrophysiol 2024; 35:1050-1054. [PMID: 38501328 DOI: 10.1111/jce.16249] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.
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Affiliation(s)
- Allan Plant
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Fergus Stewart
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Darren Hooks
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
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Tomaselli M, Radu DN, Badano LP, Perelli FP, Heilbron F, Cascella A, Gavazzoni M, Hădăreanu DR, Mihaila S, Oliverio G, Penso M, Caravita S, Baratto C, Fisicaro S, Parati G, Muraru D. Right Atrial Remodeling and Outcome in Patients with Secondary Tricuspid Regurgitation. J Am Soc Echocardiogr 2024; 37:495-505. [PMID: 38218553 DOI: 10.1016/j.echo.2024.01.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In patients with secondary tricuspid regurgitation (STR), right atrial remodeling (RAR) is a proven marker of disease progression. However, the prognostic value of RAR, assessed by indexed right atrial volume (RAVi) and reservoir strain (RAS), remains to be clarified. Accordingly, the aim of our study is to investigate the association with outcome of RAR in patients with STR. METHODS We enrolled 397 patients (44% men, 72.7 ± 13 years old) with mild to severe STR. Complete two-dimensional and speckle-tracking echocardiography analysis of right atrial and right ventricular (RV) size and function were obtained in all patients. The primary end point was the composite of death from any cause and heart failure hospitalization. RESULTS After a median follow-up of 15 months (interquartile range, 6-23), the end point was reached by 158 patients (39%). Patients with RAS <13% and RAVi >48 mL/m2 had significantly lower survival rates compared to patients with RAS ≥13% and RAVi ≤48 mL/m2 (log-rank P < .001). On multivariable analysis, RAS <13% (hazard ratio, 2.11; 95% CI, 1.43-3.11; P < .001) and RAVi > 48 mL/m2 (hazard ratio, 1.49; 95% CI, 1.01-2.18; P = .04) remained associated with the combined end point, even after adjusting for RV free-wall longitudinal strain, significant chronic kidney disease, and New York Heart Association class. Secondary tricuspid regurgitation excess mortality increased exponentially with values of 18.2% and 51.3 mL/m2 for RAS and RAVi, respectively. In nested models, the addition of RAS and RAVi provided incremental prognostic value over clinical, conventional echocardiographic parameters of RV size and function and RV free-wall longitudinal strain. CONCLUSIONS In patients with STR, RAR was independently associated with mortality and heart failure hospitalization. Assessment of RAR could improve risk stratification of patients with STR, potentially identifying those who may benefit from optimization of medical therapy and a closer follow-up.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Daniela N Radu
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco P Perelli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Andrea Cascella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Diana R Hădăreanu
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, Romania
| | - Sorina Mihaila
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Marco Penso
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Samantha Fisicaro
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Polewczyk A, Jacheć W, Nowosielecka D, Kutarski A. Tricuspid valve damage and improvement following transvenous lead extraction procedures. J Cardiovasc Electrophysiol 2024; 35:939-941. [PMID: 38515000 DOI: 10.1111/jce.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland
- Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Poland Department of Cardiology, Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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Bartkowiak J, Vivekanantham H, Kassar M, Dernektsi C, Agarwal V, Lebehn M, Windecker S, Brugger N, Hahn RT, Praz F. Computed tomography anatomic predictors of outcomes in patients undergoing tricuspid transcatheter edge-to-edge repair. J Cardiovasc Comput Tomogr 2024; 18:259-266. [PMID: 38383226 DOI: 10.1016/j.jcct.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
AIM To identify anatomical computed tomography (CT) predictors of procedural and clinical outcomes in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER). METHODS AND RESULTS Consecutive patients undergoing T-TEER between March 2018 to December 2022 who had cardiac CT prior to the procedure were included. CT scans were automatically analyzed using a dedicated software that employs deep learning techniques to provide precise anatomical measurements and volumetric calculations. Technical success was defined as successful placement of at least one implant in the planned anatomic location without single leaflet device attachment. Procedural success was defined as tricuspid regurgitation reduction to moderate or less. Procedural complexity was assessed by measuring the fluoroscopy time. The clinical endpoint was a composite of death, heart failure hospitalization, or tricuspid re-intervention throughout two years. A total of 33 patients (63.6% male) were included. Procedural success was achieved in 22 patients (66.7%). Shorter end-systolic (ES) height between the inferior vena cava (IVC) and tricuspid annulus (TA) (r = - 0.398, p = 0.044) and longer ES RV length (r = 0.551, p = 0.006) correlated with higher procedural complexity. ES RV length was independently associated with lower technical(adjusted Odds ratio [OR] 0.812 [95% CI 0.665-0.991], p = 0.040) and procedural success (adjusted OR 0.766, CI [0.591-0.992], p = 0.043). Patients with ES right ventricular (RV) length of >77.4 mm had a four-fold increased risk of experiencing the composite clinical endpoint compared to patients with ES RV length ≤77.4 mm (HR = 3.964 [95% CI, 1.018-15.434]; p = 0,034]). CONCLUSION CT-derived RV length and IVC-to-TA height may be helpful to identify patients at increased risk for procedural complexity and adverse outcomes when undergoing T-TEER. CT provides valuable information for preprocedural decision-making and device selection.
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Affiliation(s)
- Joanna Bartkowiak
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Hari Vivekanantham
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland; Arrhythmia Services, Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Chrisoula Dernektsi
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Vratika Agarwal
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Mark Lebehn
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Rebecca T Hahn
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Fabien Praz
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland.
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Kirchner J, Gesch J, Gercek M, Piran M, Friedrichs K, Pfister R, Rudolph F, Potratz M, Goncharov A, Ivannikova M, Rudolph V, Rudolph TK. Analysis of tricuspid annulus dimensions and RCA-proximity with artificial intelligence-based software for procedural planning of percutaneous tricuspid annuloplasty. J Cardiovasc Comput Tomogr 2024; 18:309-310. [PMID: 38290934 DOI: 10.1016/j.jcct.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Johannes Kirchner
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Johannes Gesch
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Muhammed Gercek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Misagh Piran
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Felix Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Max Potratz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Arsenyi Goncharov
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Maria Ivannikova
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Shanafelt C, Middour TG, Ibrahim R, Leal M, Lloyd MS, Shah AD, Westerman SB, El-Chami MF, Merchant FM, Bhatia NK. Outcomes of tricuspid regurgitation after lead extraction. J Cardiovasc Electrophysiol 2024; 35:929-938. [PMID: 38450808 DOI: 10.1111/jce.16227] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/04/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. METHODS We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0 = none/trivial, 1 = mild, 2 = moderate, 3 = severe). A change of >1 grade following extraction was considered significant. RESULTS A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference on average TR grade pre- and postextraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p = 0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e., >1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR postextraction (44.0% vs. 31.6%, p = 0.04). CONCLUSION In our single-center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction.
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Affiliation(s)
- Colby Shanafelt
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas G Middour
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rand Ibrahim
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Miguel Leal
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Murphy SP, Lew J, Yucel E, Singh J, Mela T. Cardiac implantable electronic device-induced tricuspid regurgitation: Implications and management. J Cardiovasc Electrophysiol 2024; 35:1017-1025. [PMID: 38501386 DOI: 10.1111/jce.16251] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead-induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing-induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre-existing TR have not been consistent predictors of CIED-induced TR. While two-dimensional echocardiography is helpful in assessing the severity of TR, three-dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three-dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED-induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important.
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Affiliation(s)
- Sean P Murphy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanney Lew
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evin Yucel
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jagmeet Singh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theofanie Mela
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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Fortmeier V, Körber MI, Rommel KP, Stolz L, Kassar M, Praz F, Pfister R, Hausleiter J, Lurz P, Rudolph V. New Diagnostic Criteria for Pulmonary Hypertension: Impact on Survival Prognostication Following Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2024; 17:1073-1075. [PMID: 38658125 DOI: 10.1016/j.jcin.2024.01.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/26/2024]
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Onohara D, Silverman M, Suresh KS, Xu D, He Q, King CL, Tom SK, Kalra K, Padala M. An Animal Model of Functional Tricuspid Regurgitation by Leaflet Tethering Using Image-Guided Chordal Encircling Snares. J Cardiovasc Transl Res 2024; 17:417-425. [PMID: 37615887 DOI: 10.1007/s12265-023-10424-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Several interventional therapies are in development to treat functional tricuspid regurgitation. Most have failed to achieve adequate efficacy, as animal models of this lesion are lacking. We developed a new image-guided technique in swine, by tethering the tricuspid valve chordae using echo-guided chordal encircling snares. Five swine underwent baseline echocardiographic assessment of tricuspid valve function, followed by echo-guided placement of snares that encircle the chordae inserting into the anterior and posterior tricuspid valve leaflets. Tethering these snares and stabilizing them on the right ventricle caused the regurgitant fraction to increase from 8.48±5.38% to 48.76±12.5%, and the valve tenting area to increase from 60.26±52.19 to 160.9±86.92 mm2. Image-guided chordal encircling snares could reproducibly induce clinically significant levels of functional tricuspid regurgitation and create a valve geometry like that seen in patients, providing a new animal model for use to study novel interventional devices.
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Affiliation(s)
- Daisuke Onohara
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Silverman
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirthana Sreerangathama Suresh
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Dongyang Xu
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Qi He
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Chase L King
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie K Tom
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kanika Kalra
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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12
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Yoshida K, Axelsen JB, Saku K, Andersen A, de Man FS, Sunagawa K, Vonk Noordegraaf A, Bogaard HJ. How to incorporate tricuspid regurgitation in right ventricular-pulmonary arterial coupling. J Appl Physiol (1985) 2023; 135:53-59. [PMID: 37227183 DOI: 10.1152/japplphysiol.00081.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023] Open
Abstract
Adaptation of the right ventricle (RV) to a progressively increasing afterload is one of the hallmarks of pulmonary arterial hypertension (PAH). Pressure-volume loop analysis provides measures of load-independent RV contractility, i.e., end-systolic elastance, and pulmonary vascular properties, i.e., effective arterial elastance (Ea). However, PAH-induced RV overload potentially results in tricuspid regurgitation (TR). TR makes RV eject to both PA and right atrium; thereby, a ratio of RV end-systolic pressure (Pes) to RV stroke volume (SV) could not correctly define Ea. To overcome this limitation, we introduced a two-parallel compliance model, i.e., Ea = 1/(1/Epa + 1/ETR), while effective pulmonary arterial elastance (Epa = Pes/PASV) represents pulmonary vascular properties and effective tricuspid regurgitant elastance (ETR) represents TR. We conducted animal experiments to validate this framework. First, we performed SV analysis with a pressure-volume catheter in the RV and a flow probe at the aorta in rats with and without pressure-overloaded RV to determine the effect of inferior vena cava (IVC) occlusion on TR. A discordance between the two techniques was found in rats with pressure-overloaded RV, not in sham. This discordance diminished after IVC occlusion, suggesting that TR in pressure-overloaded RV was diminished by IVC occlusion. Next, we performed pressure-volume loop analysis in rats with pressure-overloaded RVs, calibrating RV volume by cardiac magnetic resonance. We found that IVC occlusion increased Ea, suggesting that a reduction of TR increased Ea. Using the proposed framework, Epa was indistinguishable to Ea post-IVC occlusion. We conclude that the proposed framework helps better understanding of the pathophysiology of PAH and associated right heart failure.NEW & NOTEWORTHY This study reveals the impact of tricuspid regurgitation on pressure-volume loop analysis in right ventricle pressure overload. By introducing a novel concept of parallel compliances in the pressure-volume loop analysis, a better description is provided for the right ventricular forward afterload in the presence of tricuspid regurgitation.
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Affiliation(s)
- Keimei Yoshida
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kenji Sunagawa
- Circulatory System Research Foundation, Kyushu University, Fukuoka, Japan
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
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13
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Lee JY, Li WY, Wu CI, Huang MS, Lee WH, Liu YW, Tsai WC. Significance of strictly defined idiopathic tricuspid regurgitation. J Chin Med Assoc 2023; 86:176-182. [PMID: 36306389 DOI: 10.1097/jcma.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Moderate to severe tricuspid regurgitation (TR) is known to cause right ventricular (RV) failure and death. Although TR is traditionally classified as primary or secondary, recently, a new class of TR called idiopathic TR has been proposed, with varying definitions among different studies. METHODS The data were retrospectively collected for the period of January to June 2018 for 8711 patients from the patient cohort of the National Cheng Kung University Hospital echocardiography laboratory. A total of 670 patients (7.7%) with moderate-to-severe TR were included. Idiopathic TR was diagnosed strictly using a new systematic approach. RESULTS The distribution of significant TR included 74 (11.0%) primary TR cases, 48 (7.2%) with pacemaker-related TR, 267 (39.9%) with left heart disease, 24 (3.6%) with congenital heart disease, 6 (0.9%) with RV myopathy, 105 (15.7%) with pulmonary hypertension, and 146 (21.8%) with idiopathic TR. The mean age in primary and idiopathic TR groups was older ( p = 0.004), with lower estimated pulmonary pressure ( p < 0.001), higher RV fraction area change (FAC, p < 0.001), and tricuspid annulus systolic velocity (S', p = 0.004) compared with functional TR group. Multivariate analysis showed that idiopathic TR ( p = 0.002) and primary TR ( p = 0.008) had better RV FAC than functional TR. CONCLUSION Idiopathic TR was associated with better RV function than the other secondary TRs. Thus, idiopathic TR should be strictly defined and regarded as a distinct type of TR.
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Affiliation(s)
- Jen-Yuan Lee
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, ROC
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wen-Yao Li
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Chun-I Wu
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan, ROC
| | - Mu-Shiang Huang
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wen-Huang Lee
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Yen-Wen Liu
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
| | - Wei-Chuan Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan, ROC
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan, ROC
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Harada T, Obokata M, Omote K, Iwano H, Ikoma T, Okada K, Yoshida K, Kato T, Kurosawa K, Nagai T, Anzai T, Borlaug BA, Kurabayashi M. Functional Tricuspid Regurgitation and Right Atrial Remodeling in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2022; 162:129-135. [PMID: 34702555 DOI: 10.1016/j.amjcard.2021.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022]
Abstract
Tricuspid regurgitation (TR) is common in patients with heart failure with preserved ejection fraction (HFpEF), but it has not been well characterized. We hypothesized that right atrial (RA) remodeling would be associated with TR in HFpEF, forming a type of atrial functional TR (AFTR). Echocardiography was performed in 328 patients with HFpEF. TR severity was defined using a guidelines-based approach. Ventricular functional TR was defined as the presence of right ventricular (RV) systolic pressure >50 mm Hg or RV dilation, and the remaining patients were classified as having AFTR if they had RA dilation or tricuspid annular enlargement. RA dilation was common (78%) in the significant TR group (more than mild), exceeding the prevalence of RV dilation (32%), and RA dilation was correlated with tricuspid annular diameter and TR vena contracta width (r = 0.67 and r = 0.70, both p <0.0001). Despite the absence of RV dilation and pulmonary hypertension, 38% of patients with significant TR had AFTR. Patients with AFTR and those with ventricular functional TR displayed higher heart failure hospitalization rates than those with nonsignificant TR (adjusted hazard ratios, 2.45 and 4.31; 95% confidence interval 1.12 to 5.35 and 2.44 to 7.62, p = 0.02 and p <0.0001, respectively). In conclusion, TR in HFpEF is related to RA remodeling, and the presence of AFTR was associated with poor clinical outcomes. The current data highlight the importance of RA remodeling in the pathophysiology of TR in HFpEF.
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Affiliation(s)
- Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Ikoma
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Japan
| | - Kenya Okada
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Japan
| | - Kuniko Yoshida
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshimitsu Kato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Koji Kurosawa
- Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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15
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Sadeh B, Itach T, Merdler I, Frydman S, Morgan S, Zahler D, Peri Y, Hochstadt A, Pasternak Y, Topilsky Y, Banai S, Shacham Y. Prognostic Implication of Tricuspid Regurgitation in ST-segment Elevation Myocardial Infarction Patients. Isr Med Assoc J 2021; 23:783-787. [PMID: 34954917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is associated with adverse prognosis in various patient populations, but currently no data is available about the prevalence and prognostic implication of TR in ST-segment elevation myocardial infarction (STEMI) patients. OBJECTIVES To investigate the possible implication of TR among STEMI patients. METHODS We conducted a retrospective study of STEMI patients undergoing primary percutaneous coronary intervention (PCI) and its relation to major clinical and echocardiographic parameters. Patient records were assessed for the prevalence and severity of TR, its relation to the clinical profile, key echocardiographic parameters, in-hospital outcomes, and long-term mortality. Patients with previous myocardial infarction or known previous TR were excluded. RESULTS The study included 1071 STEMI patients admitted between September 2011 and May 2016 (age 61 ± 13 years; predominantly male). A total of 205 patients (19%) had mild TR while another 32 (3%) had moderate or greater TR. Patients with significant TR demonstrated worse echocardiographic parameters, were more likely to have in-hospital complications, and had higher long-term mortality (28% vs. 6%; P < 0.001). Following adjustment for significant clinical and echocardiographic parameters, mortality hazard ratio of at least moderate to severe TR remained significant (hazard ratio 2.44; 95% confidence interval 1.06-5.62; P = 0.036) for patients with moderate-severe TR. CONCLUSIONS Among STEMI patients after primary PCI, the presence of moderate-severe TR was independently associated with adverse outcomes and significantly lower survival rate.
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Affiliation(s)
- Ben Sadeh
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Itach
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shir Frydman
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yotam Pasternak
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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16
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Affiliation(s)
- Karima Addetia
- Noninvasive Cardiac Imaging Laboratories, Department of Medicine, Section of Cardiology, Heart & Vascular Center, University of Chicago Medicine, 5758 S. Maryland Avenue, MR 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Roberto M Lang
- Noninvasive Cardiac Imaging Laboratories, Department of Medicine, Section of Cardiology, Heart & Vascular Center, University of Chicago Medicine, 5758 S. Maryland Avenue, MR 9067, DCAM 5509, Chicago, IL 60637, USA
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17
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Sadeh B, Itach T, Merdler I, Frydman S, Morgan S, Zahler D, Peri Y, Hochstadt A, Pasternak Y, Topilsky Y, Banai S, Shacham Y. Prognostic Implication of Tricuspid Regurgitation in ST-segment Elevation Myocardial Infarction Patients. Isr Med Assoc J 2021; 23:441-446. [PMID: 34251128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is associated with adverse prognosis in various patient populations but currently no data is available about the prevalence and prognostic implication of TR in ST-segment elevation myocardial infarction (STEMI) patients. OBJECTIVES To investigate the possible implication of TR among STEMI patients. METHODS We conducted a retrospective study of STEMI patients undergoing primary percutaneous coronary intervention (PCI), and its relation to major clinical and echocardiographic parameters. Patient records were assessed for the prevalence and severity of TR as well as the relation to the clinical profile, key echocardiographic parameters, in-hospital outcomes, and long-term mortality. Patients with previous myocardial infarction or known previous TR were excluded. RESULTS The study included 1071 STEMI patients admitted between September 2011 and May 2016 (age 61 ± 13 years; predominantly male). A total of 205 patients (19%) had mild TR while another 32 (3%) had moderate or greater TR. Patients with significant TR demonstrated worse echocardiographic parameters, were more likely to have in-hospital complications, and had higher long-term mortality (28% vs. 6%, P < 0.001). Following adjustment for significant clinical and echocardiographic parameters, mortality hazard ratio of at least moderate to severe TR remained significant (2.44, 95% confidence interval 1.06-5.6, P = .036) for patients with moderate to severe TR. CONCLUSIONS Among STEMI patients after primary PCI, the presence of moderate to severe TR was independently associated with adverse outcomes and significantly lower survival rate.
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Affiliation(s)
- Ben Sadeh
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Itach
- Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Pasternak
- Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Benz DC, Fuchs TA. How equilibrium radionuclide angiography can quantify tricuspid regurgitation. J Nucl Cardiol 2021; 28:873-875. [PMID: 31350716 DOI: 10.1007/s12350-019-01826-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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19
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Eyharts D, Lavie-Badie Y, Cazalbou S, Fournier P, Cariou E, Pascal P, Campelo-Parada F, Marcheix B, Galinier M, Berry I, Carrié D, Lairez O. Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography. J Nucl Cardiol 2021; 28:864-872. [PMID: 31201690 DOI: 10.1007/s12350-019-01781-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. AIMS To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). METHODS AND RESULTS Sixty-one patients (44 men; mean age 59 ± 12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. There was a significant correlation between RVol as assess by ERV and by TTE (R = 0.95, P < 0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P < 0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R = 0.81 and R = 0.75, respectively (all P < 0.0001). CONCLUSION TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.
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Affiliation(s)
- Damien Eyharts
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Cazalbou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Eve Cariou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Pierre Pascal
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
| | - Francisco Campelo-Parada
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France.
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
- Heart Valve Center, Toulouse University Hospital, Toulouse, France.
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Fortuni F, Butcher SC, Dietz MF, van der Bijl P, Prihadi EA, De Ferrari GM, Ajmone Marsan N, Bax JJ, Delgado V. Right Ventricular-Pulmonary Arterial Coupling in Secondary Tricuspid Regurgitation. Am J Cardiol 2021; 148:138-145. [PMID: 33667451 DOI: 10.1016/j.amjcard.2021.02.037] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
Chronic pressure-overload induces right ventricular (RV) adaptation to maintain RV-pulmonary arterial (PA) coupling. RV remodeling is frequently associated with secondary tricuspid regurgitation (TR) which may accelerate uncoupling. Our aim is to determine whether the non-invasive analysis of RV-PA coupling could improve risk stratification in patients with secondary TR. A total of 1,149 patients (median age 72[IQR, 63 to 79] years, 51% men) with moderate or severe secondary TR were included. RV-PA coupling was estimated using the ratio between two standard echocardiographic measurements: tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). The risk of all-cause mortality across different values of TAPSE/PASP was analyzed with a spline analysis. The cut-off value of TAPSE/PASP to identify RV-PA uncoupling was based on the spline curve analysis. At the time of significant secondary TR diagnosis the median TAPSE/PASP was 0.35 (IQR, 0.25 to 0.49) mm/mm Hg. A total of 470 patients (41%) demonstrated RV-PA uncoupling (<0.31 mm/mm Hg). Patients with RV-PA uncoupling presented more frequently with heart failure symptoms had larger RV and left ventricular dimensions, and more severe TR compared to those with RV-PA coupling. During a median follow-up of 51 (IQR, 17 to 86) months, 586 patients (51%) died. The cumulative 5-year survival rate was lower in patients with RV-PA uncoupling compared to their counterparts (37% vs 64%, p < 0.001). After correcting for potential confounders, RV-PA uncoupling was the only echocardiographic parameter independently associated with all-cause mortality (HR 1.462; 95% CI 1.192 to 1.793; p < 0.001). In conclusion, RV-PA uncoupling in patients with secondary TR is independently associated with poor prognosis and may improve risk stratification.
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Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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21
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Barker CM, Cork DP, McCullough PA, Mehta HS, Van Houten J, Gunnarsson C, Ryan M, Irish W, Mollenkopf S, Verta P. Comparison of Survival in Patients With Clinically Significant Tricuspid Regurgitation With and Without Heart Failure (From the Optum Integrated File). Am J Cardiol 2021; 144:125-130. [PMID: 33385352 DOI: 10.1016/j.amjcard.2020.12.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
This study aimed to quantify survival rates for patients with tricuspid regurgitation (TR) using real-world data. Several clinical conditions are associated with TR, including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser co-morbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared with patients with TR alone. TR severity was also significantly associated (hazard ratio = 1.33; p = 0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD before their TR diagnosis.
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Affiliation(s)
- Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, California
| | | | | | | | - William Irish
- Brody School of Medicine, Greenville, North Carolina
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22
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Freud LR, Wilkins-Haug LE, Beroukhim RS, LaFranchi T, Phoon CK, Glickstein JS, Cumbermack KM, Makhoul M, Morris SA, Sun HY, Ferrer Q, Pedra SR, Tworetzky W. Effect of In Utero Non-Steroidal Anti-Inflammatory Drug Therapy for Severe Ebstein Anomaly or Tricuspid Valve Dysplasia (NSAID Therapy for Fetal Ebstein anomaly). Am J Cardiol 2021; 141:106-112. [PMID: 33217351 DOI: 10.1016/j.amjcard.2020.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD) are rare congenital malformations associated with nearly 50% mortality when diagnosed in utero. The diseases often produce severe tricuspid regurgitation (TR) in the fetus and in some cases, pulmonary regurgitation (PR) and circular shunting ensue. Since the ductus arteriosus (DA) plays a critical role in the circular shunt and may be constricted by transplacental nonsteroidal anti-inflammatory drugs (NSAIDs), we sought to assess the effect of NSAIDs on fetuses with EA/TVD. We reviewed mothers of singleton fetuses with EA/TVD and PR, indicative of circular shunting, who were offered NSAIDs at multiple centers from 2010 to 2018. Initial dosing consisted of indomethacin, followed by ibuprofen in most cases. Twenty-one patients at 10 centers were offered therapy at a median gestational age (GA) of 30.0 weeks (range: 20.9 to 34.9). Most (15/21 = 71%) mothers received NSAIDs, and 12 of 15 (80%) achieved DA constriction after a median of 2.0 days (1.0 to 6.0). All fetuses with DA constriction had improved PR; 92% had improved Doppler patterns. Median GA at pregnancy outcome (live-birth or fetal demise) was 36.1 weeks (30.7 to 39.0) in fetuses with DA constriction versus 33 weeks (23.3 to 37.3) in fetuses who did not receive NSAIDs or achieve DA constriction (p = 0.040). Eleven of 12 patients (92%) with DA constriction survived to live-birth, whereas 4 of 9 patients (44%) who did not receive NSAIDs or achieve DA constriction survived (p = 0.046). In conclusion, our findings demonstrate the proof of concept that NSAIDs mitigate circular shunt physiology by DA constriction and improve PR among fetuses with severe EA/TVD. Although the early results are encouraging, further investigation is necessary to determine safety and efficacy.
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Affiliation(s)
- Lindsay R Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York.
| | - Louise E Wilkins-Haug
- Department of Obstetrics, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
| | - Rebecca S Beroukhim
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Terra LaFranchi
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colin K Phoon
- Department of Pediatrics, Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University, New York, New York
| | - Julie S Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York
| | - Kristopher M Cumbermack
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Majd Makhoul
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Shaine A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Heather Y Sun
- Department of Pediatrics, Division of Pediatric Cardiology, Rady Children's Hospital, University of California-San Diego, San Diego, California
| | - Queralt Ferrer
- Department of Pediatrics, Division of Pediatric Cardiology, University Hospital Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Simone R Pedra
- Department of Pediatrics, Division of Pediatric Cardiology, Instituto Dante Pazzanese de Cardiologia/Hospital do Coracao da Associacao Sanatorio Sirio, Sao Paulo, Brazil
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Bannehr M, Kahn U, Liebchen J, Okamoto M, Hähnel V, Georgi C, Dworok V, Edlinger C, Lichtenauer M, Kücken T, Kropf S, Haase-Fielitz A, Butter C. Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation. Can J Cardiol 2021; 37:1086-1093. [PMID: 33453358 DOI: 10.1016/j.cjca.2021.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR. METHODS Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed. RESULTS Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001). CONCLUSIONS Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.
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Affiliation(s)
- Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Ulrike Kahn
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Josephin Liebchen
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Maki Okamoto
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Valentin Hähnel
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Victoria Dworok
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany; Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tanja Kücken
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Siegfried Kropf
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany; Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
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24
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Geyer M, Keller K, Bachmann K, Born S, Tamm AR, Ruf TF, Kreidel F, Hahad O, Petrescu A, Hell M, Beiras-Fernandez A, Kornberger A, Schulz E, Münzel T, von Bardeleben RS. Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair. Clin Res Cardiol 2021; 110:676-688. [PMID: 33433670 PMCID: PMC8099767 DOI: 10.1007/s00392-020-01798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract ![]()
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Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tobias Friedrich Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Aniela Petrescu
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Andres Beiras-Fernandez
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Angela Kornberger
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Affiliation(s)
- M Adam Ali
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.
| | - Matthew Colquhoun
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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26
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Mathur M, Malinowski M, Timek TA, Rausch MK. Tricuspid Annuloplasty Rings: A Quantitative Comparison of Size, Nonplanar Shape, and Stiffness. Ann Thorac Surg 2020; 110:1605-1614. [PMID: 32251659 PMCID: PMC11040511 DOI: 10.1016/j.athoracsur.2020.02.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation due to annular and ventricular dilatation is increasingly recognized as a significant source of morbidity and mortality. To repair the annulus, surgeons implant one of many annuloplasty devices that differ in size, 3-dimensional (3D) shape, and stiffness. However, there have been no quantitative comparisons between various available devices. METHODS Three-dimensional scanning, micro-computed tomography imaging, analytical methods, and mechanical tests were used to compare 3 Edwards Lifesciences (Irvine, CA) and 3 Medtronic (Minneapolis, MN) annuloplasty devices of all available sizes. We measured in-plane metrics of maximum diameter, perimeter, area, height, as well as elevation and curvature profiles. Furthermore, we computed bending stiffness as well as the maximum and minimum axes of the bending stiffness. RESULTS Most annular prostheses differed little in their in-plane geometries but varied significantly in height. In-plane properties deviated significantly from measurements of healthy human tricuspid annuli. Height of the Edwards' MC3 and Medtronic's Contour 3D resembled healthy human tricuspid valve annuli, whereas the Edwards' Physio and Classic, and Medtronic's TriAd, did not. Additionally, the elevation profiles of the MC3 and Contour 3D and curvature profiles between all devices were consistent and matched those of healthy human annuli. The tested devices also differed in their bending stiffness, both in terms of absolute values and their maximum and minimum axes. CONCLUSIONS Contoured devices, such as Edwards' MC3 and Medtronic's Contour 3D, most accurately resembled the healthy human tricuspid annulus but differed significantly in bending stiffness. To what extent prosthesis properties and shape affect tricuspid valve function remains to be determined.
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Affiliation(s)
- Mrudang Mathur
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas
| | - Marcin Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan; Department of Cardiac Surgery, Medical University of Silesia School of Medicine in Katowice, Katowice, Poland
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Manuel K Rausch
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas; Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX; Oden Institute for Computational Engineering and Science, The University of Texas at Austin, Austin, Texas.
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27
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Kücken T, Tamm S, Haase-Fielitz A, Edlinger CR, Neuss M, Bannehr M, Butter C. Visualisation of the tricuspid valve using a new 3D echocardiographic scoring system. Open Heart 2020; 7:openhrt-2020-001363. [PMID: 32994355 PMCID: PMC7526282 DOI: 10.1136/openhrt-2020-001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022] Open
Abstract
With rising focus on interventional treatment of the tricuspid valve (TV), the need for good echocardiographic imaging increases. Aim of this study was to develop a scoring system describing how accurate three dimensional (3D) echocardiographic imaging of TV and its anatomical structures is.
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Affiliation(s)
- Tanja Kücken
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Sarah Tamm
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Anja Haase-Fielitz
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | | | - Michael Neuss
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Marwin Bannehr
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Christian Butter
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
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28
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Sulejmani F, Pataky J, Sun W. Mechanical and Structural Evaluation of Tricuspid Bicuspidization in a Porcine Model. Cardiovasc Eng Technol 2020; 11:522-531. [PMID: 32737819 DOI: 10.1007/s13239-020-00480-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/22/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tricuspid regurgitation (TR) affects approximately 1.6 million Americans and is associated with just a 63.9% 1-year survival rate in its moderate to severe forms due to its asymptomatic nature and late diagnosis and surgical referral. As a result, industrial fervor has begun to broach this topic, with several percutaneous treatment devices currently under development. As much remains unknown about the tricuspid apparatus, the mechanics of these procedures remain unquantified. In this study, a testing apparatus and technique for the evaluation of percutaneous tricuspid valve (TV) bicuspidization were developed for the evaluation of these parameters in twelve porcine hearts. METHODS The passive relaxed myocardial state and the active contracted state were each induced in six porcine hearts and the bicuspidization experiment was run twice, the second time after induction of TR. TV annular area, cinching force, static leakage through the TV annulus, and annular ellipticity were quantified and compared among the groups. RESULTS The use of phenol was effective to induce functional TR by increased annular area. Cinching force was not found to differ between any of the testing states, but the bicuspidization experiment was able to reduce the TR annular area to that of its healthy counterpart in addition to reducing static leakage through the TV annulus. Despite appropriately reducing the area, bicuspidization was found to induce a more circular TV annular shape. CONCLUSION Taken together, these results provide a first mechanical analysis of the TV bicuspidization mechanism and may serve as a point of reference for future clinical animal studies.
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Affiliation(s)
- Fatiesa Sulejmani
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Joshua Pataky
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
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29
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Cui H, Su J, Liang WW, Wang HL, Wang HF. Diagnostic analysis of abnormal increase of PASP in fetus in middle- and late-stage pregnancy by color Doppler echocardiography. Br J Radiol 2020; 93:20191011. [PMID: 32160003 PMCID: PMC10993218 DOI: 10.1259/bjr.20191011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Our study was conducted with an attempt to investigate the diagnostic analysis of abnormal increase of fetal pulmonary artery systolic pressure (PASP) in middle and late pregnancy by color Doppler echocardiography. METHODS From August 2017 to January 2019, 52 fetuses with moderate or greater tricuspid high-speed regurgitation were retrospectively analyzed and selected as Group A. 88 fetuses with full-color blood flow of the two ventricles and symmetrical sizes of the cardiac cavities on both sides harboring tricuspid valve and mild regurgitation or a small amount of regurgitation were selected as Group B. The pulmonary artery blood flow acceleration time (AT) and right ventricular ejection time (ET) was measured, and the PASP was calculated. RESULTS The tricuspid regurgitation velocity, tricuspid regurgitation pressure difference and PASP in Group A were higher than those in Group B (p < 0.05), and the AT and AT/ET values in Group A were lower than those in Group B (p < 0.05). Gestational age, tricuspid regurgitation velocity and tricuspid regurgitation pressure difference were positively correlated with PASP. However, AT/ET and AT value were negatively correlated with PASP. CONCLUSION The abnormal increase of pulmonary artery can be assessed by color Doppler echocardiography of fetal tricuspid regurgitation, which is worth popularizing and applying in clinic. ADVANCES IN KNOWLEDGE It was suggested that the middle- and late-stage fetuses with moderate or greater tricuspid regurgitation and with >20 mmHg regurgitation pressure difference should be followed up in clinic. If PASP was ≥70 mmHg with symptoms of right heart failure, fetuses should be closely observed until 35-36 weeks old to ensure fetal safety and early delivery would be recommended.
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Affiliation(s)
- Hong Cui
- Department of Ultrasound, Taian City Central
Hospital, Taian, Shandong,
China
| | - Juan Su
- Department of Ultrasound, Taian City Central
Hospital, Taian, Shandong,
China
| | - Wen-Wen Liang
- Department of Ultrasound, Taian City Central
Hospital, Taian, Shandong,
China
| | - Hong-Ling Wang
- Department of Ultrasound, Taian City Central
Hospital, Taian, Shandong,
China
| | - Hui-Feng Wang
- Department of Ultrasound, Taian City Central
Hospital, Taian, Shandong,
China
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30
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Karam N, Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Ho E, Biasco L, Orban M, Deseive S, Braun D, Gavazzoni M, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. Value of Echocardiographic Right Ventricular and Pulmonary Pressure Assessment in Predicting Transcatheter Tricuspid Repair Outcome. JACC Cardiovasc Interv 2020; 13:1251-1261. [PMID: 32360260 DOI: 10.1016/j.jcin.2020.02.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the value of echocardiographic right ventricular (RV) and systolic pulmonary artery pressure (sPAP) assessment in predicting transcatheter tricuspid edge-to-edge valve repair (TTVR) outcome. BACKGROUND RV dysfunction and pulmonary hypertension are associated with poor prognosis and are systematically sought during tricuspid regurgitation evaluation. The value of echocardiographic assessment in predicting TTVR outcome is unknown. METHODS Data were taken from the TriValve (Transcatheter Tricuspid Valve Therapies) registry, which includes patients undergoing TTVR at 14 European and North American centers. The primary outcome was 1-year survival free from hospitalization for heart failure, and secondary outcomes were 1-year survival and absence of hospital admission for heart failure at 1 year. RESULTS Overall, 249 patients underwent TTVR between June 2015 and 2018 (mean tricuspid annular plane systolic excursion [TAPSE] 15.8 ± 15.3 mm, mean sPAP 43.6 ± 16.0 mm Hg). Tricuspid regurgitation grade ≥3+ was found in 96.8% of patients at baseline and 29.4% at final follow-up; 95.6% were in New York Heart Association functional class III or IV initially, compared with 34.3% at follow-up (p < 0.05). Final New York Heart Association functional class did not differ among TAPSE and sPAP quartiles, even when both low TAPSE and high sPAP were present. Rates of 1-year survival and survival free from hospitalization for heart failure were 83.9% and 78.7%, respectively, without significant differences according to baseline echocardiographic RV characteristics (TAPSE, fractional area change, and end-diastolic area) and sPAP (p > 0.05 for all). CONCLUSIONS TTVR provides clinical improvement, with 1-year survival free from hospital readmission >75% in patients with severe tricuspid regurgitation. Conventional echocardiographic parameters used to assess RV function and sPAP did not predict clinical outcome after TTVR.
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Affiliation(s)
- Nicole Karam
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; European Hospital Georges Pompidou, Cardiology Department, Université de Paris, PARCC, INSERM, Paris, France
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | - Davide Schiavi
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | - Edwin Ho
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mara Gavazzoni
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
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Jacobs K, Rigdon J, Chan F, Cheng JY, Alley MT, Vasanawala S, Maskatia SA. Direct measurement of atrioventricular valve regurgitant jets using 4D flow cardiovascular magnetic resonance is accurate and reliable for children with congenital heart disease: a retrospective cohort study. J Cardiovasc Magn Reson 2020; 22:33. [PMID: 32404159 PMCID: PMC7222506 DOI: 10.1186/s12968-020-00612-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method. METHODS We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5 T or 3 T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard) = stroke volume by 2D balanced steady-state free precession - semilunar valve forward flow (SLFF); annular inflow method (AIM) = atrioventricular valve forward flow [AVFF] - semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]× 100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired t-test, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate. RESULTS Regurgitant fraction by JET strongly correlated with the indirect methods (VOL and AIM) (ρ = 0.73-0.80, p < 0.001) and was similar to VOL with a median difference (interquartile range) of - 1.5% (- 8.3-7.2%; p = 0.624). VOL had weaker correlations with AIM and JET (ρ = 0.69-0.73, p < 0.001). AIM underestimated RF by 3.6-6.9% compared to VOL and JET, p < 0.03. Intra- and inter- observer reliability were excellent for all methods (ICC 0.94-0.99). The mean (±standard deviation) inter-observer difference for VOL was 2.4% (±5.1%), p < 0.05. CONCLUSIONS In a diverse cohort of pediatric CHD, measurement of AVVR using JET is accurate and reliable to VOL and is a superior method of internal validation compared to AIM. This study supports use of 4DF CMR for measurement of AVVR, obviating need for expert prospective prescription during image acquisition by 2D CMR.
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Affiliation(s)
- Kimberley Jacobs
- Department of Pediatrics, Stanford University School of Medicine, 725 Welch Rd, Room G71, MC 5906, Palo Alto, CA, 94304, USA.
| | - Joseph Rigdon
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Frandics Chan
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Joseph Y Cheng
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Marcus T Alley
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shreyas Vasanawala
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shiraz A Maskatia
- Department of Pediatrics, Divisions of Pediatric Cardiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
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Parikh P, Banerjee K, Ali A, Anumandla A, Patel A, Jobanputra Y, Menon V, Griffin B, Tuzcu EM, Kapadia S. Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries. Open Heart 2020; 7:e001183. [PMID: 32399250 PMCID: PMC7204555 DOI: 10.1136/openhrt-2019-001183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Tricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after NCS. Methods We performed a retrospective cohort study in patients undergoing NCS. Outcomes in patients with moderate or severe TR were compared with no/trivial TR after adjusting for baseline characteristics and revised cardiac risk index (RCRI). The primary outcome was defined as 30-day mortality and heart failure (HF), while the secondary outcome was long-term mortality. Results Of the 7064 patients included, 312 and 80 patients had moderate and severe TR, respectively. Thirty-day mortality was higher in moderate TR (adjusted OR 2.44, 95% CI 1.25 to 4.76) and severe TR (OR 2.85, 95% CI 1.04 to 7.79) compared with no/trivial TR. There was no difference in 30-day HF in patients with moderate TR (OR 1.48, 95% CI 0.90 to 2.44) or severe TR (OR 1.42, 95% CI 0.60 to 3.39). The adjusted HR for long-term mortality in moderate TR was 1.55 (95% CI 1.31 to 1.82) and 1.87 (95% CI 1.40 to 2.50) for severe TR compared with no/trivial TR. Conclusion Increasing TR severity has higher postoperative 30-day mortality in patients undergoing NCS, independent of RCRI risk factors, ejection fraction or mitral regurgitation. Severity of TR should be considered in risk stratification for patients undergoing NCS.
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Affiliation(s)
- Parth Parikh
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ambreen Ali
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anil Anumandla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aditi Patel
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yash Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Mathur M, Meador WD, Jazwiec T, Malinowski M, Timek TA, Rausch MK. The Effect of Downsizing on the Normal Tricuspid Annulus. Ann Biomed Eng 2020; 48:655-668. [PMID: 31659604 PMCID: PMC8353055 DOI: 10.1007/s10439-019-02387-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022]
Abstract
Tricuspid annuloplasty is a surgical procedure that cinches the valve's annulus in order to reduce regurgitant blood flow. One of its critical parameters is the degree of downsizing. To provide insight into the effect of downsizing, we studied the annulus of healthy sheep during suture annuloplasty. To this end, we implanted fiduciary markers along the annulus of sheep and subsequently performed a DeVega suture annuloplasty. We performed five downsizing steps in each animal while recording hemodynamic and sonomicrometry data in beating hearts. Subsequently, we used splines to approximate the annulus at baseline and at each downsizing step. Based on these approximations we computed clinical metrics of annular shape and dynamics, and the continuous field metrics height, strain, and curvature. With these data, we demonstrated that annular area reduction during downsizing was primarily driven by compression of the anterior annulus. Similarly, reduction in annular dynamics was driven by reduced contractility in the anterior annulus. Finally, changes in global height and eccentricity of the annulus could be explained by focal changes in the continuous height profile and changes in annular curvature. Our findings are important as they provide insight into a regularly performed surgical procedure and may inform the design of transcatheter devices that mimic suture annuloplasty.
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Affiliation(s)
- Mrudang Mathur
- Department of Mechanical Engineering, University of Texas at Austin, 204 E Dean Keeton Street, Austin, TX, 78712, USA
| | - William D Meador
- Department of Biomedical Engineering, University of Texas at Austin, 107 W Dean Keeton Street, Austin, TX, 78712, USA
| | - Tomasz Jazwiec
- Silesian Centre for Heart Diseases, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, 49503, USA
| | - Manuel K Rausch
- Departments of Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, University of Texas at Austin, 2617, Wichita Street, Austin, TX, 78712, USA.
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Pernias V, González M, Miñana G, Górriz JL, Juan I, Chorro FJ, Sanchis J, Núñez J. Refractory congestive heart failure: when the solution is outside the heart. ESC Heart Fail 2020; 7:311-314. [PMID: 31833193 PMCID: PMC7083441 DOI: 10.1002/ehf2.12554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/06/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022] Open
Abstract
Refractory congestive heart failure is associated with an ominous prognosis in which the treatments strategies remain scarce and not well validated. In the last years, continuous ambulatory peritoneal dialysis (CAPD) has emerged as a therapeutic alternative in this subset of patients. So far, it has been associated with a significant improvement in functional capacity and quality of life, together with a striking reduction in the risk of readmissions. We present the case of an elderly patient with severe left ventricular dysfunction and severe mitral and tricuspid regurgitation who presents recurrent admissions for anasarca. After its inclusion in a CAPD programme, the patient experienced a marked clinical and biochemical improvement despite the persistence of cardiac abnormalities. CAPD onset translates into greater sodium removal. We want to emphasize the usefulness of this therapy in the management of volume excess in patients with refractory heart failure and renal failure promoting a greater sodium removal compared with traditional diuretic strategies.
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Affiliation(s)
- Vicente Pernias
- Fundación de InvestigacionHospital Clínico Universitario de Valencia (INCLIVA)ValenciaSpain
| | - Miguel González
- Nephrology DepartmentHospital Clínico UniversitarioValenciaSpain
| | - Gema Miñana
- Fundación de InvestigacionHospital Clínico Universitario de Valencia (INCLIVA)ValenciaSpain
- Cardiology DepartmentHospital Clínico UniversitarioAvda. Blasco Ibáñez 17Valencia46010Spain
- Departamento de MedicinaUniversidad de ValenciaValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Jose Luis Górriz
- Nephrology DepartmentHospital Clínico UniversitarioValenciaSpain
- Departamento de MedicinaUniversidad de ValenciaValenciaSpain
| | - Isabel Juan
- Nephrology DepartmentHospital Clínico UniversitarioValenciaSpain
| | - Francisco J. Chorro
- Fundación de InvestigacionHospital Clínico Universitario de Valencia (INCLIVA)ValenciaSpain
- Cardiology DepartmentHospital Clínico UniversitarioAvda. Blasco Ibáñez 17Valencia46010Spain
- Departamento de MedicinaUniversidad de ValenciaValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Juan Sanchis
- Fundación de InvestigacionHospital Clínico Universitario de Valencia (INCLIVA)ValenciaSpain
- Cardiology DepartmentHospital Clínico UniversitarioAvda. Blasco Ibáñez 17Valencia46010Spain
- Departamento de MedicinaUniversidad de ValenciaValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Julio Núñez
- Fundación de InvestigacionHospital Clínico Universitario de Valencia (INCLIVA)ValenciaSpain
- Cardiology DepartmentHospital Clínico UniversitarioAvda. Blasco Ibáñez 17Valencia46010Spain
- Departamento de MedicinaUniversidad de ValenciaValenciaSpain
- CIBER CardiovascularMadridSpain
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Zaikokuji K, Mizuno A, Ogawa T, Saito J, Suda H. Mitral valve repair for a patient with presternal esophageal reconstruction. Asian Cardiovasc Thorac Ann 2019; 27:587-589. [PMID: 31490735 DOI: 10.1177/0218492319827663] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 68-year-old man presented with dyspnea and pulsation. He had a history of esophagectomy and presternal gastric tube reconstruction for esophageal cancer 1 year earlier. Electrocardiography revealed atrial fibrillation, and an echocardiogram showed severe mitral valve regurgitation and moderate tricuspid valve regurgitation. He underwent mitral valve repair, tricuspid valve annuloplasty, and isolation of bilateral pulmonary veins via a standard median sternotomy. The mitral and tricuspid valves were evaluated by epicardial echocardiography, and both valves were successfully repaired. The postoperative course was uneventful. The patient was discharged without any complications 6 days after the operation.
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Affiliation(s)
- Kenta Zaikokuji
- 1 Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Akihiro Mizuno
- 1 Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Tatsuhito Ogawa
- 1 Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Jien Saito
- 1 Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Hisao Suda
- 2 Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Wiley BM, Luoma CE, Olgun Kucuk H, Padang R, Kane GC, Pellikka PA. Lung Ultrasound During Stress Echocardiography Aids the Evaluation of Valvular Heart Disease Severity. JACC Cardiovasc Imaging 2019; 13:866-872. [PMID: 31422148 DOI: 10.1016/j.jcmg.2019.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Brandon M Wiley
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Charles E Luoma
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hilal Olgun Kucuk
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiac Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Biasco L, Orban M, Deseive S, Braun D, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. 1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation: Results From the TriValve Registry. JACC Cardiovasc Interv 2019; 12:1451-1461. [PMID: 31395215 DOI: 10.1016/j.jcin.2019.04.019] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate procedural and 1-year clinical and echocardiographic outcomes of patients treated with tricuspid edge-to-edge repair. BACKGROUND Transcatheter edge-to-edge repair has been successfully performed in selected patients with symptomatic tricuspid regurgitation (TR) and high risk for surgery, but outcome data are sparse. METHODS This analysis of the multicenter international TriValve (Transcatheter Tricuspid Valve Therapies) registry included 249 patients with severe TR treated with edge-to-edge repair in compassionate and/or off-label use. Clinical and echocardiographic outcomes were prospectively collected and retrospectively analyzed. RESULTS In 249 patients (mean age 77 ± 9 years; European System for Cardiac Operative Risk Evaluation II score 6.4% [interquartile range: 3.9% to 13.9%]), a successful procedure with TR reduction to grade ≤2+ was achieved in 77% by placement of 2 ± 1 tricuspid clips. Concomitant treatment of severe TR and mitral regurgitation was performed in 52% of patients. At 1-year follow-up, significant and durable improvements in TR severity (TR ≤2+ in 72% of patients) and New York Heart Association functional class (≤II in 69% of patients) were observed. All-cause mortality was 20%, and the combined rate of mortality and unplanned hospitalization for heart failure was 35%. Predictors of procedural failure included effective regurgitant orifice area, tricuspid coaptation gap, tricuspid tenting area, and absence of central or anteroseptal TR jet location. Predictors of 1-year mortality were procedural failure, worsening kidney function, and absence of sinus rhythm. CONCLUSIONS Transcatheter tricuspid edge-to-edge repair can achieve TR reduction at 1 year, resulting in significant clinical improvement. Predictors of procedural failure and 1-year mortality identified here may help select patients who will benefit most from this therapy.
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Affiliation(s)
- Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | | | | | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Gilbert H L Tang
- Westchester Medical Center, Valhalla, New York; Mount Sinai Medical Center, New York, New York
| | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- San Raffaele University Hospital, Milan, Italy
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
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Affiliation(s)
- Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alok Kumar Sharma
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Ledwoch J, Fellner C, Poch F, Schlatterbeck L, Dommasch M, Dirschinger R, Stundl A, Laugwitz KL, Kupatt C, Hoppmann P. Reverse Cardiac Remodeling After Transcatheter Treatment of Severe Tricuspid Regurgitation Using the Edge-to-Edge MitraClip Technique. J Invasive Cardiol 2019; 31:89-93. [PMID: 30927530] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In recent years, transcatheter treatment techniques for tricuspid regurgitation (TR) have rapidly evolved. Cardiac remodeling analysis beyond clinical outcome assessment following transcatheter tricuspid repair is still lacking. The aim of the present case series was to analyze cardiac remodeling after tricuspid valve repair using the edge-to-edge MitraClip technique. METHODS Echocardiographic analysis was performed prior to MitraClip implantation and at 3-month and 6-month follow-up exams. RESULTS Six consecutive patients undergoing MitraClip implantation between April 2017 and March 2018 at our institution were enrolled. During follow-up, TR reduction was durable in all patients, without recurrence of severe TR. Compared to baseline, right ventricular function improved in 5 out of 6 patients. Reduction in right ventricular area was observed in the majority of patients and reduction in right atrial volume was observed in all subjects. Patients also experienced beneficial left cardiac remodeling. CONCLUSION The present series indicates that transcatheter treatment of severe TR using the edge-to-edge MitraClip technique can lead to reverse cardiac remodeling, which is not commonly seen in surgically treated patients.
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Affiliation(s)
- Jakob Ledwoch
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Yuan F, Wu Z, Jiang L, Zhou J, Xu L, Liu H, Ma L, Zhai Z, Zhang J. Short-Term Effects of Tolvaptan in Tricuspid Insufficiency Combined with Left Heart Valve Replacement-Caused Volume-Overload Patients: Results of a Prospective Pilot Study. Am J Cardiovasc Drugs 2019; 19:211-218. [PMID: 30255476 DOI: 10.1007/s40256-018-0304-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). METHODS This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10 days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. RESULTS TAPSE significantly increased in the tolvaptan group compared with the control group after 10 days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4 days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. CONCLUSIONS Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier no. NCT02644616.
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Affiliation(s)
- Fang Yuan
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Zhangmin Wu
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Li Jiang
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China.
| | - Jun Zhou
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Lei Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Lan Ma
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Zhenzhou Zhai
- Department of Emergency, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Junjie Zhang
- Department of Emergency, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
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41
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Affiliation(s)
- Pulkit Chaudhury
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Paulino Alvarez
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Fujioka T, Kühn A, Sanchez-Martinez S, Bijnens BH, Hui W, Slorach C, Roehlig C, Mertens L, Vogt M, Friedberg MK. Impact of Interventricular Interactions on Left Ventricular Function, Stroke Volume, and Exercise Capacity in Children and Adults With Ebstein's Anomaly. JACC Cardiovasc Imaging 2018; 12:925-927. [PMID: 30553666 DOI: 10.1016/j.jcmg.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/14/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022]
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Zhan HY, Xu FQ, Liu CX, Zhao G. Clinical applicability of monitoring pulmonary artery blood flow acceleration time variations in monitoring fetal pulmonary artery pressure. ADV CLIN EXP MED 2018; 27:1723-1727. [PMID: 30129292 DOI: 10.17219/acem/75686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In recent years, pulmonary artery blood flow acceleration time (AT) has been believed to be applicable in the examination of fetal lung development. OBJECTIVES This study aims to evaluate the clinical significance of pulmonary artery blood flow AT as a parameter in monitoring of fetal pulmonary artery pressure. MATERIAL AND METHODS A total of 31 fetuses in midor late-term pregnancy with tricuspid regurgitation were set as the study group (congenital heart disease with a tricuspid regurgitation pressure difference of more than 20 mm Hg was excluded). A total of 68 normal fetuses in midor late-term pregnancy were selected as the control group (strictly screened for tricuspid regurgitation, congenital heart disease and other congenital diseases before inclusion). The average ATs of both groups were calculated. Correlations of pulmonary artery systolic pressure (PASP) and AT, as well as the ratio of AT to right ventricular ejection time (ET) (AT/ET ratio) of both groups were investigated by 1-way analysis of variance (ANOVA). RESULTS The average AT of the study group was significantly lower than that of the control group (p < 0.0001). In the study group, AT negatively correlated with PASP (r = -0.52; p < 0.01), AT/ET ratio negatively correlated with PASP (r = -0.52; p < 0.01) and both showed statistical significance. CONCLUSIONS The results indicated that fetuses in the study group showed lower ATs and AT/ET ratios than the control group. Acceleration times and AT/ET ratios decreased as PASP increased. Thus, AT and AT/ET ratio can be used clinically as new parameters for the qualitative and - to some extent - quantitative evaluation of fetal pulmonary artery pressure.
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Affiliation(s)
- Hong-Yan Zhan
- Department of B-Ultrasound, Fourth People's Hospital of Jinan, China
| | - Feng-Qin Xu
- Department of B-Ultrasound, Fourth People's Hospital of Jinan, China
| | - Chuan-Xi Liu
- Department of B-Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Gang Zhao
- Department of Emergency Surgery, Shandong Province Qianfoshan Hospital, Shandong University, Jinan, China
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Gheorghe L, Swaans M, Denti P, Rensing B, Van der Heyden J. Transcatheter Tricuspid Valve Repair With a Novel Cinching System. JACC Cardiovasc Interv 2018; 11:e199-e201. [PMID: 30503598 DOI: 10.1016/j.jcin.2018.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Livia Gheorghe
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Martin Swaans
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Paolo Denti
- Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Bernard Rensing
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
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Khan JM, Rogers T, Schenke WH, Greenbaum AB, Babaliaros VC, Paone G, Ramasawmy R, Chen MY, Herzka DA, Lederman RJ. Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve. Catheter Cardiovasc Interv 2018; 92:E175-E184. [PMID: 29405564 PMCID: PMC6078835 DOI: 10.1002/ccd.27531] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. BACKGROUND Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. METHODS Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. RESULTS Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naïve) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naïve) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naïve) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P < .01) using this strategy compared to single puncture techniques used to anchor current investigational devices. Serious complications were related to apical access. CONCLUSIONS PASTA reduces annular dimensions and tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.
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Affiliation(s)
- Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam B. Greenbaum
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Gaetano Paone
- Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Y. Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel A. Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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So CY, Tam KC, Lam YY, Lee APW. Single Leaflet Device Attachment Complicating Percutaneous Edge-to-Edge Repair of the Tricuspid Valve Using the MitraClip. J Invasive Cardiol 2018; 30:E93-E94. [PMID: 30158327] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 72-year-old woman with severe mitral and tricuspid regurgitation secondary to chronic atrial fibrillation presented with refractory heart failure despite optimal medical treatment. She was considered inoperable, and thus underwent transcatheter edge-to-edge repair of both valves using the MitraClip system as a compassionate use.
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Affiliation(s)
| | | | | | - Alex Pui-Wai Lee
- 9/F Department of Medicine and Therapeutics, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR.
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Adam AM, Godil A, Ali Mallick MS, Khan F, Rizvi AH, Makhdoom IUHM. Lutembacher syndrome with mitral valve calcification in a 31-year old male. J PAK MED ASSOC 2018; 68:340-342. [PMID: 29786701] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lutembacher syndrome is characterized by a congenital ostium secundum atrial septal defect and an acquired mitral valve stenosis. We present a similar case in a 31-year old male who came in with orthopnoea, central cyanosis and pedal oedema. Examination revealed cardiac murmurs in tricuspid and apical regions. Chest x-ray showed signs of pulmonary congestion and ventricular enlargement. Electrocardiogaphy (ECG) revealed right axis deviation and right bundle branch block along with atrial fibrillation and Transthoracic Echocardiography (TTE) showed abnormal valves (mitral stenosis with calcification and tricuspid regurgitation) and dilated cardiac chambers. The patient was consequently treated with beta-blockers and diuretics and scheduled for valvular and septal repair via open heart surgery. The purpose of this case report is to assist cardiologists in diagnosing this syndrome accurately on the basis of symptoms and investigations.
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Affiliation(s)
| | | | | | - Fahad Khan
- Dow University of Health Sciences, Karachi
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Driessen MMP, Schings MA, Sieswerda GT, Doevendans PA, Hulzebos EH, Post MC, Snijder RJ, Westenberg JJM, van Dijk APJ, Meijboom FJ, Leiner T. Tricuspid flow and regurgitation in congenital heart disease and pulmonary hypertension: comparison of 4D flow cardiovascular magnetic resonance and echocardiography. J Cardiovasc Magn Reson 2018; 20:5. [PMID: 29332606 PMCID: PMC5767973 DOI: 10.1186/s12968-017-0426-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tricuspid valve (TV) regurgitation (TR) is a common complication of pulmonary hypertension and right-sided congenital heart disease, associated with increased morbidity and mortality. Estimation of TR severity by echocardiography and conventional cardiovasvular magnetic resonance (CMR) is not well validated and has high variability. 4D velocity-encoded (4D-flow) CMR was used to measure tricuspid flow in patients with complex right ventricular (RV) geometry and varying degrees of TR. The aims of the present study were: 1) to assess accuracy of 4D-flow CMR across the TV by comparing 4D-flow CMR derived TV effective flow to 2D-flow derived effective flow across the pulmonary valve (PV); 2) to assess TV 4D-flow CMR reproducibility, and 3) to compare TR grade by 4D-flow CMR to TR grade by echocardiography. METHODS TR was assessed by both 4D-flow CMR and echocardiography in 21 healthy subjects (41.2 ± 10.5 yrs., female 7 (33%)) and 67 RV pressure-load patients (42.7 ± 17.0 yrs., female 32 (48%)). The CMR protocol included 4D-flow CMR measurement across the TV, 2D-flow measurement across the PV and conventional planimetric measurements. TR grading on echocardiographic images was performed based on the international recommendations. Bland-Altman analysis and intra-class correlation coefficients (ICC) were used to asses correlations and agreement. RESULTS TV effective flow measured by 4D-flow CMR showed good correlation and agreement with PV effective flow measured by 2D-flow CMR with ICC = 0.899 (p < 0.001) and mean difference of -1.79 ml [limits of agreement -20.39 to 16.81] (p = 0.084). Intra-observer agreement for effective flow (ICC = 0.981; mean difference - 1.51 ml [-12.88 to 9.86]) and regurgitant fraction (ICC = 0.910; mean difference 1.08% [-7.90; 10.06]) was good. Inter-observer agreement for effective flow (ICC = 0.935; mean difference 2.12 ml [-15.24 to 19.48]) and regurgitant fraction (ICC = 0.968; mean difference 1.10% [-7.96 to 5.76]) were comparable. In 25/65 (38.5%) TR grade differed by at least 1 grade using 4D-flow CMR compared to echocardiography. CONCLUSION TV effective flow derived from 4D-flow CMR showed excellent correlation to PV effective flow derived from 2D-flow CMR, and was reproducible to measure TV flow and regurgitation. Twenty-five out of 65 patients (38.5%) were classified differently by at least one TR grade using 4D-flow CMR compared to echocardiography.
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Affiliation(s)
- Mieke M. P. Driessen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- ΙCΙN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Marjolijn A. Schings
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Erik H. Hulzebos
- Department of Paediatric Physical Therapy and Exercise Physiology, Child Development and Exercise Centre, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marco C. Post
- Department of Cardiology, Antonius Hospital, Nieuwegein, the Netherlands
| | - Repke J. Snijder
- Department of Pulmonology, Antonius Hospital, Nieuwegein, the Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie P. J. van Dijk
- Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Folkert J. Meijboom
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Nakano Y, Okumura N, Adachi S, Shimokata S, Tajima F, Kamimura Y, Murohara T, Kondo T. Left ventricular end-diastolic dimension and septal e' are predictors of cardiac index at rest, while tricuspid annular plane systolic excursion is a predictor of peak oxygen uptake in patients with pulmonary hypertension. Heart Vessels 2017; 33:521-528. [PMID: 29143104 PMCID: PMC5911277 DOI: 10.1007/s00380-017-1086-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/01/2017] [Indexed: 01/07/2023]
Abstract
Little is known regarding a correlation of hemodynamics at rest or exercise capacity with echocardiographic parameters in patients with pulmonary hypertension (PH). To clarify these potential correlations, we performed transthoracic echocardiography, right heart catheterization, and cardiopulmonary exercise testing in 53 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Left ventricular end-diastolic dimension (LVDd), early diastolic velocity of the septal mitral annulus (septal e'), tricuspid regurgitation peak gradient (TRPG), and tricuspid annular plane systolic excursion (TAPSE) were significantly correlated with cardiac index (LVDd; r = 0.477, P < 0.001, septal e'; r = 0.463, P = 0.001, TRPG; r = - 0.455, P = 0.001 and TAPSE; r = 0.406, P = 0.003, respectively). Multiple regression analysis revealed that LVDd and septal e' were significantly associated with cardiac index (CI) and stroke volume index at rest. Among the exercise capacity markers evaluated, TAPSE, TRPG, and LVDd were significantly correlated with peak oxygen uptake (TAPSE; r = 0.534, P < 0.001, TRPG; r = - 0.466, P = 0.001 and LVDd; r = 0.411, P = 0.002, respectively). Multiple regression analysis showed that TAPSE was significantly associated with peak oxygen uptake (VO2). In PAH and CTEPH patients, LVDd and septal e' were significantly associated with CI at rest, whereas TAPSE was significantly associated with peak VO2. Echocardiographic parameters may predict the prognostic factors of PAH and CTEPH patients.
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Affiliation(s)
- Yoshihisa Nakano
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Okumura
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shiro Adachi
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shigetake Shimokata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Tajima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Kamimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Kondo
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan.
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Hong JA, Kim MS, Cho MS, Choi HI, Kang DH, Lee SE, Lee GY, Jeon ES, Cho JY, Kim KH, Yoo BS, Lee JY, Kim WJ, Kim KH, Chung WJ, Lee JH, Cho MC, Kim JJ. Clinical features of idiopathic restrictive cardiomyopathy: A retrospective multicenter cohort study over 2 decades. Medicine (Baltimore) 2017; 96:e7886. [PMID: 28885342 PMCID: PMC6393124 DOI: 10.1097/md.0000000000007886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Idiopathic restrictive cardiomyopathy (RCMP) has not been fully understood because this disease is difficult to diagnose. The present study aimed to assess the clinical profile and outcome of idiopathic RCMP from a multicenter cohort.This investigation is a retrospective study of consecutive patients with idiopathic RCMP at 10 centers in Korea between 1990 and 2010. We evaluated the clinical characteristics of the patients and prognostic factors associated with mortality using multivariate Cox proportional hazards regression analyses.The study included 53 patients (26 men, 49.1%). During a median follow-up of 1.7 years, 17 patients (32.1%) died and 5 patients (9.4%) received a heart transplant. The 5-year survival rate of the overall patients was 64.4% ± 7.8%. In multivariable analyses, the predictors of mortality were tricuspid regurgitation (TR) ≥ moderate (hazard ratio [HR] 32.55, P < .001) and left ventricular end-diastolic diameter (LVEDD) (HR 0.85, P < .001).Idiopathic RCMP showed unfavorable prognosis. Advanced TR and lower LVEDD are independent adverse predictors of mortality in patients with idiopathic RCMP.
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Affiliation(s)
- Jung Ae Hong
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Su Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyo In Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang-Eun Lee
- Department of Internal Medicine, Seoul National University Hospital
| | - Ga-Yeon Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun-Seok Jeon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jae-Yeong Cho
- Department of Cardiology, Translational Research Center on Aging, Chonnam National University Hospital, Gwangju
| | - Kye-Hun Kim
- Department of Cardiology, Translational Research Center on Aging, Chonnam National University Hospital, Gwangju
| | - Byung-Su Yoo
- Department of Internal Medicine, Wonju College of Medicine,Yonsei University, Wonju
| | - Jong-Young Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul
| | - Won-Jang Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University school of Medicine, Bundang
| | | | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon
| | - Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
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