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Alfonso F, Salamanca J, Núñez-Gil I, Ibáñez B, Sanchis J, Sabaté M, Velázquez M, Raposeiras-Roubín S, García-Camarero T, Antuña P, Mejía H, Carrillo X, Buera I, Martínez-Sellés M, Escudier-Villa JM, Sánchez-Prieto J, Ponce EB, Cabezón G, Fernández-Golfín C, Pascual-Figal D, Cid B, Marcano A, González-Manzanares R, Jiménez-Valero S, Manuel Vázquez J, Sanz-Sánchez J, Cecconi A, Val DD, Abad-Santos F, Crea F. Rationale and design of the beta-blockers in tako-tsubo syndrome study: a randomized clinical trial (β-Tako). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00367-0. [PMID: 39743172 DOI: 10.1016/j.rec.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/12/2024] [Indexed: 01/04/2025]
Abstract
Introduction y objectives: Tako-tsubo syndrome (TTS) is a cardiac condition that mimics acute coronary syndrome, characterized by transient left ventricular dysfunction in the absence of culprit coronary artery stenosis. Although its etiology remains unknown, reversible microvascular dysfunction secondary to an adrenergic surge is thought to play a role. Treatment is empirical, although most patients receive beta-blockers (BB) in clinical practice. The Beta-blockers in Tako-tsubo Syndrome study (β-Tako), is an academic, multicenter, pragmatic, prospective randomized open-label trial with blinded endpoint evaluation that aims to assess the efficacy and safety of BB in patients with TTS. METHODS The diagnosis of TTS will be confirmed by invasive coronary angiography and serial echocardiographic assessments. Two hundred patients with TTS will be randomized (1:1) to BB (n = 100) or no BB (n = 100). BB with alpha or nitric oxide release activity will be used in the treatment arm. RESULTS The primary efficacy endpoint is the comparison of the wall motion score index by echocardiography at 7 days, analyzed by an independent core laboratory. Changes in left ventricular ejection fraction and global longitudinal strain will also be evaluated. A composite clinical endpoint (death, stroke, admission for recurrent TTS, acute coronary syndrome, heart failure, or atrial fibrillation) at 1 year will be assessed by an independent clinical events committee. Several predefined substudies will be conducted to examine clinical, imaging, biomarker, pharmacogenetic, inflammatory, messenger ribonucleic acids, and quality-of-life parameters. CONCLUSIONS The β-Tako trial will generate robust scientific evidence to address unmet clinical needs and inform clinical and treatment decisions in this uniquely challenging clinical entity. The study has been registered (EU-CT number: 2023-510213-25-01, ClinicalTrials.gov Identifier, NCT06509074.
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Rivas García S, González Ferrer E, Gámez Guijarro I, Ortega Pérez R, Fernández Santos S, Carrión Sánchez I, García-Sebastián C, García Martín A, Pardo Sanz A, Salido Tahoces L, Remior Pérez P, Castillo Olive M, Fernández-Golfín C, Zamorano JL. Reversible Cause of Heart Failure? Circ Heart Fail 2024; 17:e011619. [PMID: 39422995 DOI: 10.1161/circheartfailure.124.011619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
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Arteagoitia-Bolumburu A, García-Sebastián C, Carrión-Sánchez I, Sánchez-Recalde Á, Fernández-Golfín C. Delayed iatrogenic atrial septal defect after implantation of a bicaval prosthesis device for the treatment of tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2024; 25:e272. [PMID: 39086152 DOI: 10.1093/ehjci/jeae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/02/2024] Open
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Carrión-Sánchez I, García-Martín A, Arribas-Marcos Á, Sánchez-Recalde Á, Zamorano JL, Fernández-Golfín C. Enhancing interventional imaging: the role of computed tomography and intraproducedural echocardiography in the diagnosis and management of acquired pulmonary vein stenosis. THE JOURNAL OF INVASIVE CARDIOLOGY 2024. [PMID: 39441762 DOI: 10.25270/jic/24.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
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Salido-Tahoces L, Sánchez-Recalde Á, Fernández-Golfín C, Zamorano-Gómez JL. Percutaneous closure of incomplete surgical left atrial appendage ligation: success begins with the decision to try. THE JOURNAL OF INVASIVE CARDIOLOGY 2024; 36. [PMID: 38662952 DOI: 10.25270/jic/24.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The authors present a case of percutaneous closure of an incomplete surgical left atrial appendage (LAA) ligation with a new device LAmbre (Lifetech ScientificCo Ltd).
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Fernández-Golfín C, García-Martín A, Carrión I, Salido Tahoces L, Zamorano JL. Less is more: X-ray-TEE fusion with a new mini probe. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae088. [PMID: 39318450 PMCID: PMC11421467 DOI: 10.1093/ehjimp/qyae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/17/2024] [Indexed: 09/26/2024]
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Hinojar R, Fernández-Golfín C, González Gómez A, García-Martin A, Monteagudo JM, García Lunar I, García Sebastian C, Pardo A, Sanchez Recalde A, Zamorano JL. STREI: a new index of right heart function in isolated severe tricuspid regurgitation by speckle-tracking echocardiography. Eur Heart J Cardiovasc Imaging 2024; 25:520-529. [PMID: 37956101 DOI: 10.1093/ehjci/jead305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS Right ventricular (RV) performance determines clinical management in severe tricuspid regurgitation (TR). Right atrial (RA) function complements RV assessment in TR. This study aimed to design a novel index by speckle-tracking echocardiography (STREI index) integrating RA and RV strain information and to evaluate the clinical utility of combining RV and RA strain for prediction of cardiovascular (CV) outcomes. METHODS AND RESULTS Consecutive patients with at least (≥) severe TR evaluated in the Heart Valve Clinic (n = 300) were prospectively included. An additional independent TR cohort was included for external validation (n = 50). STREI index was developed with the formula: [2 ∗ RV-free wall longitudinal strain (RV-FWLS)] + reservoir RA strain (RASr). The composite endpoint included hospital admission due to heart failure and all-cause mortality. A total of 176 patients with ≥severe TR were finally included. STREI index identified a higher percentage of patients with RV dysfunction compared with conventional parameters. After a median follow-up of 2.2 years (interquartile range: 12-41 months), a total of 38% reached the composite endpoint. STREI values were predictors of outcomes independently of TR severity and RV dimensions. The combination of prognostic cut-off values of RASr (<10%) and RV-FWLS (>-20%) (STREI stratification) stratified four different groups of risk independently of TR severity, RV dimensions, and clinical status (adj HR per stratum 1.89 (1.4-2.34), P < 0.001). Pre-defined cut-off values achieved similar prognostic performance in the validation cohort (n = 50). CONCLUSION STREI index is a novel parameter of RV performance that independently predicts CV events. The combination of RA and RV strain stratifies better patients' risk, reflecting a broader effect of TR on right heart chambers.
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Fernández-Golfín C, González-Gómez A. Unmasking tricuspid regurgitation. Int J Cardiol 2024; 398:131609. [PMID: 38036267 DOI: 10.1016/j.ijcard.2023.131609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
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Pardo-Sanz A, Zamorano JL, Hinojar-Baydes R, Salido-Tahoces L, García-Sebastián C, González-Gomez A, García-Martín A, Fernández-Golfín C, Sánchez-Recalde Á. Long-term right heart remodeling after transcatheter tricuspid annuloplasty assessed by cardiac tomography. J Cardiovasc Comput Tomogr 2024; 18:215-216. [PMID: 38142219 DOI: 10.1016/j.jcct.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023]
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Sánchez-Recalde Á, Salido-Tahoces L, García-Martín A, Carrión-Sánchez I, González-Gomez A, Pardo-Sanz A, García-Sebastian C, Hinojar-Baydes R, Fernández-Golfín C, Zamorano JL. Concomitant Transcatheter Tricuspid Annuloplasty and Edge-to-Edge Repair in Torrential Tricuspid Regurgitation. JACC Cardiovasc Interv 2024; 17:99-100. [PMID: 38069994 DOI: 10.1016/j.jcin.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
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Sánchez-Recalde Á, Pardo-Sanz A, Hinojar-Baydes R, Salido-Tahoces L, García-Sebastian C, González-Gomez A, García-Martín A, Fernández-Golfín C, Zamorano JL. Tricuspid Annulus Reduction Mechanism After Transcatheter Annuloplasty and its Impact on Right Ventricular Remodeling. JACC Cardiovasc Interv 2024; 17:108-110. [PMID: 38069992 DOI: 10.1016/j.jcin.2023.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
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González-Gómez A, Fernández-Golfín C, Hinojar R, Monteagudo JM, García A, García-Sebastián C, García-Lunar I, Sánchez-Recalde Á, Salido L, Pardo A, Zamorano JL. The 4A classification for patients with tricuspid regurgitation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:845-851. [PMID: 36898521 DOI: 10.1016/j.rec.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Clinical evaluation of TR patients is challenging. Our aim was to establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its prognostic performance. METHODS We included patients with isolated TR that was at least severe and without previous episodes of heart failure (HF) who were assessed in the heart valve clinic. We registered signs and symptoms of asthenia, ankle swelling, abdominal pain or distention and/or anorexia and followed up the patients every 6 months. The 4A classification ranged from A0 (no A) to A3 (3 or 4 As present). We defined a combined endpoint consisting of hospital admission due to right HF or cardiovascular mortality. RESULTS We included 135 patients with significant TR between 2016 and 2021 (69% females, mean age 78±7 years). During a median follow-up of 26 [IQR, 10-41] months, 39% (n=53) patients had the combined endpoint: 34% (n=46) were admitted for HF and 5% (n=7) died. At baseline, 94% of the patients were in NYHA I or II, while 24% were in classes A2 or A3. The presence of A2 or A3 conferred a high incidence of events. The change in 4A class remained an independent marker of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class, 1.95 [1.37-2.77]; P<.001). CONCLUSIONS This study reports a novel clinical classification specifically for patients with TR that is based on signs and symptoms of right HF and has prognostic value for events.
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Hinojar R, Fernández-Golfín C, Gómez AG, García-Martin A, Monteagudo JM, Lunar IG, Sebastian CG, Rivas S, Recalde AS, Zamorano JL. Clinical utility and prognostic value of right atrial function in severe tricuspid regurgitation: one more piece of the puzzle. Eur Heart J Cardiovasc Imaging 2023:7129743. [PMID: 37073554 DOI: 10.1093/ehjci/jead052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 04/20/2023] Open
Abstract
AIMS The optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown. This study aimed to describe RA function by 2D speckle-tracking echocardiography (STE) in at least severe TR and to evaluate its potential association with cardiovascular outcomes. METHODS AND RESULTS Consecutive patients with at least (≥) severe TR (severe, massive, or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent isolated atrial fibrillation (AF) were included for comparison (control and AF group, respectively). RA function was measured with 2D-STE and two components of RA function were calculated: reservoir (RASr) and contractile (RASct) strain (AutoStrain, Philips Medical Systems the EPIQ system). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. Patients with ≥ severe TR (n = 140) showed lower RASr compared with controls (n = 20) and with the AF group (n = 20) (P < 0.001). Atrial TR showed lower RASr compared with other aetiologies of TR (P < 0.001). After a median follow-up of 2.2 years (IQR: 12-41 months), RASr remained an independent predictor of mortality and HF. A cut-off value of RASr of <9.4% held the best accuracy to predict outcomes. CONCLUSION RA function by 2D-STE independently predicts mortality and HF hospitalizations in patients with ≥ severe TR.
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Tahoces LS, Fernández-Golfín C, Pardo Sanz A, Zamorano-Gómez JL, Sánchez Recalde Á. Pseudoaneurysm after TAVR: how to close the hole? Eur Heart J Cardiovasc Imaging 2023; 24:e102. [PMID: 36960604 DOI: 10.1093/ehjci/jead047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023] Open
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Hinojar R, Zamorano JL, González Gómez A, García-Martin A, Monteagudo JM, García Lunar I, Sanchez Recalde A, Fernández-Golfín C. Prognostic Impact of Right Ventricular Strain in Isolated Severe Tricuspid Regurgitation. J Am Soc Echocardiogr 2023:S0894-7317(23)00094-9. [PMID: 36828258 DOI: 10.1016/j.echo.2023.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Right ventricular (RV) systolic function is an established marker of outcomes in patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction using conventional two-dimensional echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for the evaluation of RV function, with the capability to detect subclinical RV dysfunction. The aim of this study was to evaluate the prognostic value of RV strain parameters in early stages of severe TR. METHODS Consecutive patients with at least severe TR (severe, massive, or torrential) and the absence of a formal indication for tricuspid valve intervention in secondary TR evaluated in the Heart Valve Clinic were prospectively included. RV systolic function was measured using conventional echocardiographic indices (RV fractional area change, tricuspid annular plane systolic excursion, and Doppler tissue imaging S wave [S']) and speckle-tracking echocardiography-derived automatic peak global longitudinal strain and free wall longitudinal strain (FWLS) using an automated two-dimensional strain analytic software. A combined end point of hospital admission due to heart failure or all-cause mortality was defined. RESULTS A total of 266 patients were enrolled in the study, and 151 were ultimately included. Strain parameters detected a higher percentage of abnormal RV values compared with conventional indices. During a median follow-up period of 26 months (interquartile range, 13-42 months), 35% of the patients reached the combined end point. Cumulative event-free survival was significantly worse in patients with impaired RV global longitudinal strain and RV FWLS. Conventional indices of RV systolic function were not associated with outcomes (P > .05 for all). On multivariate analysis, RV FWLS was independently associated with mortality and heart failure (adjusted hazard ratio for abnormal RV FWLS, 5.90; 95% CI, 3.17-10.99; P < .001). CONCLUSION In early stages of severe TR, RV FWLS is more frequently impaired compared with conventional indices of RV function. Among all parameters, RV FWLS is the strongest predictor of mortality and heart failure, independent of additional prognostic markers.
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Rajjoub Al-Mahdi EA, Fernández Santos S, López-Menéndez J, Fernández-Golfín C, Moreno J. An Infrequent Complication of VT Ablation: Should We Perform Delayed Routine Imaging After Steam Pops? JACC Case Rep 2022; 4:655-657. [PMID: 35677793 PMCID: PMC9168779 DOI: 10.1016/j.jaccas.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Catheter ablation has become the cornerstone of the treatment of ventricular arrythmias. Nevertheless, it is crucial to recognize the adverse effects of such treatment. We present a case of an incidental diagnosis of ventricular pseudoaneurysms after catheter ablation for treatment of drug-refractory nonsustained runs of ventricular tachycardia. (Level of Difficulty: Advanced.)
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Solano-López J, Zamorano JL, García-Martín A, González Gómez A, Fernández-Golfín C, Sánchez-Recalde Á. Resultados a medio plazo de la anuloplastia tricuspídea percutánea con dispositivo Cardioband. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lauri FM, Fernández-Golfín C, Zamorano JL, Sanchez-Recalde A. Coronary compression caused by extrinsic adventitial damage: case of an early complication of trans-catheter tricuspid annuloplasty with cardioband device. Eur Heart J 2021; 42:3886. [PMID: 34406387 DOI: 10.1093/eurheartj/ehab564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
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SalidoTahoces L, Fernández-Golfín C, Sánchez Recalde A, Pardo Sanz A, Zamorano-Gómez JL. When everything seems to be lost: percutaneous mitral valve repair in a failed annuloplasty ring. Eur Heart J Cardiovasc Imaging 2021:jeab150. [PMID: 34382074 DOI: 10.1093/ehjci/jeab150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Indexed: 11/13/2022] Open
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Hinojar R, Gómez AG, García-Martin A, Monteagudo JM, Fernández-Méndez MA, de Vicente AG, Salinas GLA, Zamorano JL, Fernández-Golfín C. Impact of right ventricular systolic function in patients with significant tricuspid regurgitation. A cardiac magnetic resonance study. Int J Cardiol 2021; 339:120-127. [PMID: 34273433 DOI: 10.1016/j.ijcard.2021.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/24/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Right ventricle (RV) dilatation and dysfunction are established criteria for intervention in severe tricuspid regurgitation (TR); however thresholds to support intervention are lacking. New measures of RV function such as RV shortening (RVS) and effective RV ejection fraction (eRVEF) may be earlier markers of RV dysfunction. PURPOSE to compare the prognostic impact of different parameters of RV function and to describe cut-off values of RV size/function and TR severity of poor prognosis. METHODS Consecutive patients evaluated in the Heart Valve Clinic with significant TR (severe, massive or torrential TR) undergoing a CMR study were included. In addition to parameters of biventricular volume and function, RVS and eRVEF were assessed. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined. RESULTS 75 patients were included (age 75 ± 8 years, female 75%). During a median follow-up of 3 years (IQR: 1.4-3.9 years), 39% experienced the endpoint. Cut-off values of worse prognosis were: RVS ≥ -14%, eRVEF ≤34%, RVEF ≤58%, RV-EDV ≥100 ml/m2, TR regurgitant fraction (TRF) ≥40% and TR volume ≥ 42 ml. RVS and eRVEF identified higher rates of RV dysfunction than RVEF. After adjustment for age and LVEF, both eRVEF ≤34% (HR: 5.29 [2.25-12.4]) and RVS ≥ -14% (HR: 3.46 [1.13-9.17]) were significantly associated with outcomes. Among all parameters of RV function, eRVEF was the strongest predictor of outcomes, incremental to RVEF (ΔC-statistic 0.139 [0.040-0.237], p = 0.005). Patients with eRVEF ≤34% and RV-EDV ≥100 ml/m2 or eRVEF ≤34% and TRF ≥40% had the worst prognosis (p < 0.01 for both). CONCLUSION RVS and eRVEF identify higher rates of RV dysfunction beyond RVEF. Among all measures, eRVEF held the strongest association with outcomes, incremental to RVEF.
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Solano-López J, Zamorano JL, García-Martín A, González Gómez A, Fernández-Golfín C, Sánchez-Recalde Á. Mid-term outcomes of percutaneous tricuspid annuloplasty with the Cardioband device. ACTA ACUST UNITED AC 2021; 74:888-890. [PMID: 34001464 DOI: 10.1016/j.rec.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
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Fernández-Golfín C, Hinojar-Baydes R, González-Gómez A, Monteagudo JM, Esteban A, Alonso-Salinas G, Fernández MA, García-Martín A, Santoro C, Pascual-Izco M, Jiménez-Nacher JJ, Zamorano JL. Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation. Eur Radiol 2021; 31:5106-5115. [PMID: 33449184 DOI: 10.1007/s00330-020-07651-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Speckle-tracking echocardiography (STE) deformation parameters detect latent LV dysfunction in chronic aortic regurgitation (AR) and are associated with outcomes. The aim of the study was to evaluate cardiac magnetic resonance (CMR) feature tracking (FT) deformation parameters in asymptomatic patients with AR and implications in outcomes. METHODS Fifty-five patients with AR and 54 controls were included. Conventional functional CMR parameters, aortic regurgitant volume, and fraction were assessed. CMR-FT analysis was performed with a dedicated software. Clinical data was obtained from hospital records. A combined endpoint included all-cause mortality, cardiovascular mortality, aortic valve surgery, or cardiovascular hospital admission due to heart failure. RESULTS Left ventricular (LV) mechanics is impaired in patients with significant AR. Significant differences were noted in global longitudinal strain (GLS) between controls and AR patients (- 19.1 ± 2.9% vs - 16.5 ± 3.2%, p < 0.001) and among AR severity groups (- 18.3 ± 3.1% vs - 16.2 ± 1.6% vs - 15 ± 3.5%; p = 0.02 for AR grades I-II, III, and IV). In univariate and multivariate analyses, circumferential strain (GCS) and global radial strain (GRS) but not GLS were associated with and increased risk of the end point with a HR of 1.26 (p = 0.016, 1.04-1.52) per 1% worsening for GCS and 0.90 (p = 0.012, 0.83-0.98) per 1% worsening for GRS. CONCLUSIONS CMR-FT myocardial deformation parameters are impaired in patients with AR not meeting surgical criteria. GLS decreases early in the course of the disease and is a marker of AR severity while GCS and GRS worsen later but predict a bad prognosis, mainly the need of aortic valve surgery. KEY POINTS • CMR feature tracking LV mechanic parameters may be reduced in significant chronic AR with normal EF. • LV mechanics, mainly global longitudinal strain, worsens as AR severity increases. • LV mechanics, specially global radial and circumferential strain, is associated with a worse prognosis in AR patients.
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Rincón LM, Sanmartín M, Alonso GL, Rodríguez JA, Muriel A, Casas E, Navarro M, Carbonell A, Lázaro C, Fernández S, González P, Rodríguez M, Jiménez-Mena M, Fernández-Golfín C, Esteban A, García-Bermejo ML, Zamorano JL. Una puntuación de riesgo genético predice recurrencias en pacientes jóvenes con infarto agudo de miocardio. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sánchez-Recalde Á, Hernández-Antolín R, Salido Tahoces L, García-Martín A, Fernández-Golfín C, Zamorano JL. Anuloplastia tricuspídea percutánea con dispositivo Cardioband para el tratamiento de la insuficiencia funcional tricuspídea grave. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pardo Sanz A, Santoro C, Hinojar R, Salido L, Rajjoub EA, Monteagudo JM, García A, González A, Hernández-Antolín R, Sánchez Recalde Á, Zamorano JL, Fernández-Golfín C. Right ventricle assessment in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Echocardiography 2020; 37:586-591. [PMID: 32212399 DOI: 10.1111/echo.14633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Limited data are available regarding the evaluation of right ventricular (RV) performance in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). OBJECTIVE To evaluate the prevalence of RV dysfunction in patients with severe AS undergoing TAVI and long-term changes. METHODS Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed: RV diameters, fractional area change, tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler of the tricuspid annulus (RV-S'TDI), global longitudinal strain (RV-GLS), and free wall strain (RV-FWS). Preprocedure and 1-year echo were analyzed. RESULTS Final population included 114 patients, mean age 83.63 ± 6.31 years, and 38.2% women. The prevalence of abnormal RV function was high, variable depending on the parameter that we analyzed, and it showed a significant reduction 1 year after TAVI implantation: 13.9% vs 6.8% (TAPSE < 17mm), P = .04; 26.3% vs 20% (fractional area change < 35%), P = .048; 41.2% vs 29.2% (RV-S'TDI < 9.5cm/s), P = .04; 48.7% vs 39.5% (RV-GLS > [20]), P = .049; and 48.7% vs 28.9% (RV-FWS > [20]), P = .03. Significant differences were noted between patients with low-flow (LF) vs normal-flow (NF) AS in RV dysfunction prevalence as well as in RV function recovery which is less evident in LF compared with NF patients. CONCLUSIONS RV dysfunction is high among symptomatic AS patients undergoing TAVI, with variable prevalence depending on the echocardiographic parameter used.
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