Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis

Amano, Masashi; Izumi, Chisato; Taniguchi, Tomohiko; Morimoto, Takeshi; Miyake, Makoto; Nishimura, Shunsuke; Kitai, Takeshi; Kato, Takao; Kadota, Kazushige; Ando, Kenji; Furukawa, Yutaka; Inada, Tsukasa; Inoko, Moriaki; Ishii, Katsuhisa; Sakaguchi, Genichi; Yamazaki, Fumio; Koyama, Tadaaki; Komiya, Tatsuhiko; Yamanaka, Kazuhiro; Nishiwaki, Noboru; Kanemitsu, Naoki; Sakurai, Toshihiko; Ogawa, Tatsuya; Nakayama, Shogo; Tsuneyoshi, Hiroshi; Iwakura, Atsushi; Shiraga, Kotaro; Hanyu, Michiya; Ohno, Nobuhisa; Fukumoto, Atsushi; Yamada, Tomoyuki; Nishizawa, Junichiro; Esaki, Jiro; Minatoya, Kenji; Nakagawa, Yoshihisa; Kimura, Takeshi

doi:10.1093/ehjci/jey105

Cited by 23 publications

(11 citation statements)

References 24 publications

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“…Asymptomatic patients with a BNP level of <100 pg/mL had a relatively low event rate at 1 year of follow-up, who might be safely followed up with watchful waiting strategy. Finally, in the CURRENT AS registry, HD,46 anaemia47 and tricuspid regurgitation48 were associated with poor clinical outcomes in patients with severe AS.…”

Section: Management Of Asymptomatic Patients With Severe Asmentioning

confidence: 96%

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Taniguchi

Morimoto

Takeji

et al. 2020

Heart

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Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry was a large Japanese multicentre retrospective registry of consecutive patients with severe aortic stenosis (AS) before introduction of transcatheter aortic valve implantation. We sought to overview the data from the CURRENT AS registry to discuss the three major contemporary issues related to clinical practice in patients with severe AS: (1) under-referral/underuse of surgical aortic valve replacement (SAVR) in symptomatic patients with severe AS, (2) management of asymptomatic patients with severe AS and (3) management of patients with low-gradient severe aortic stenosis (LG-AS). First, despite the dismal prognosis of symptomatic patients with severe AS, SAVR, including those performed during follow-up, was reported to be underused. In the CURRENT AS registry, overall 53% of symptomatic patients underwent aortic valve replacement (AVR) during follow-up. Second, we reported that compared with conservative strategy, initial AVR strategy was associated with lower risk of all-cause death and heart failure hospitalisation in asymptomatic patients with severe AS. Although current recommendations for AVR are mainly dependent on the patient symptoms, some patients may not complain of any symptom because of their sedentary lifestyle. We also reported several important objective factors associated with worse clinical outcomes in asymptomatic patients with severe AS for risk stratification. Finally, initial AVR strategy was associated with better long-term clinical outcomes than conservative strategy in both patients with high-gradient AS and patients with LG-AS. The favourable effect of initial AVR strategy was also seen in patients with LG-AS with left ventricular ejection fraction of ≥50%.

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Section: Management Of Asymptomatic Patients With Severe Asmentioning

confidence: 96%

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Taniguchi

Morimoto

Takeji

et al. 2020

Heart

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“…In the last decade, our knowledge about TV anatomy, morphology, and function significantly increased due to enormous development of imaging techniques and primarily three-dimensional echocardiography (3DE) [1]. At the same time, growing data of evidence revealed the importance of functional tricuspid regurgitation (FTR) on the outcome in patients with different cardiovascular diseases (CVD) including concomitant valvular disease (aortic stenosis, mitral regurgitation), heart failure, pulmonary hypertension, and even in patients without evident CVD [2][3][4][5]. Figure 1 illustrates difference in etiologies that lead to primary (organic) and secondary (functional) tricuspid regurgitation.…”

Section: Introductionmentioning

confidence: 99%

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

et al. 2021

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Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.

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“…Furthermore, right-sided heart failure due to TR is usually controllable with diuretic drugs for a prolonged period. However, moderate to severe TR has been reported to be associated with a poor prognosis [1][2][3] and the degree of TR influences the functional status in patients after cardiac surgery [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis

Abstract: The presence of clinically significant TR concomitant with severe AS is associated with a poor long-term outcome, regardless of the initial treatment strategy.

Cited by 23 publications

References 24 publications

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

Isolated functional tricuspid regurgitation: When should we go to surgical treatment?

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