Impact of right ventricular systolic function in patients with significant tricuspid regurgitation. A cardiac magnetic resonance study

Hinojar, Rocío; Gómez, Ariana González; García-Martín, Ana; Monteagudo, J M; Fernandez-Mendez, M A; Vicente, A. García; Salinas, Gonzalo Luis Alonso; Zamorano, José Luís; Fernández-Golfín, Covadonga

doi:10.1016/j.ijcard.2021.07.023

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…Limitations of CMRI include the presence of arrhythmias and transvalvular pacemaker leads often present in patients with TR. More validation and differences in specific patient cohorts will be mandatory to strengthen the role of CMRI TR quantification in clinical practice ( 41 , 53 , 67 , 68 ).…”

Section: Discussionmentioning

confidence: 99%

Basic pathophysiology and options of treatment for surgical management of functional tricuspid regurgitation: a systematic review

Gatti¹,

Dell'Angela²,

Fiore³

et al. 2022

J Thorac Dis

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Background: Functional tricuspid regurgitation (TR) appears frequently in the presence of left-sided heart valve diseases, combined with symptoms of heart failure, worsens if left untreated, and is associated with poor patient survival. Correct indications for surgery and the choice of suitable technique, which should be based on pathophysiology of disease are of utmost importance to ensure longevity and durability of repair;particularly given the risky nature of reoperations due to residual/recurrent TR.Methods: A systematic review was performed using Embase, Ovid Medline, Cochrane, Web of Science, and Google to deepen knowledge of major and controversial aspects of the subject.Results: A total of 1,579 studies were reviewed, and 32 of these were enclosed in the final review: 13 studies were primarily focused on pathophysiology and preoperative assessment of functional TR; 19 studies on surgical treatment of functional TR. A total of 15,509 patients were included.Conclusions: Indications for treatment of TR are based on the severity of regurgitation (grading), as well as on the presence of signs and symtoms of right-sided heart failure and on the extent of tricuspid annular dilation, leaflet tethering, and pulmonary hypertension (staging of disease). Despite improved knowledge of the underlying pathophysiology of TR, issues regarding indications for treatment and options of repair remain present. There is no consensus within the scientific community, for the preferred method to quantify the severity of TR; the recently introduced 5-grade TR classification based on objective quantitative parameters has not yet become common practice. The assessment of TR during stress exercise is rarely performed, though it takes into account the changes in severity of regurgitation that occur under different physiological conditions. Magnetic resonance imaging, which is the gold standard for the right heart evaluation is occasionally carried out before surgery. The threshold beyond which the tricuspid annular dilation should be repaired is unclear and recent studies put forward the idea that it may be lower than current recommendations. Tricuspid valve annuloplasty is the most adopted surgical option today. However, the ideal annuloplasty device remains elusive. In addition, as severe leaflet tethering cannot be addressed by annuloplasty alone, the addition of new techniques further increasing leaflet coaptation might optimize longterm valve continence. Further investigations are needed to address all these issues, alongside the potential of percutaneous options.

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Section: Discussionmentioning

confidence: 99%

Basic pathophysiology and options of treatment for surgical management of functional tricuspid regurgitation: a systematic review

Gatti¹,

Dell'Angela²,

Fiore³

et al. 2022

J Thorac Dis

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“…The prognostic value of CMR for TR has been well established but there is a lack of clarity on early markers of dysfunction and prognosis, to optimize treatment timing. Wang et al 1 and Hinojar et al 3 have determined thresholds for different CMR markers, and we would suggest further data be gathered to clarify which markers are most prognostically useful.…”

Section: To the Editormentioning

confidence: 94%

“…Hinojar et al 3 studied CMR-derived early markers of right ventricular (RV) dysfunction in severe TR. Effective RV ejection fraction ≥34% and RV shortening of ≥14% were associated with better prognosis for a combined endpoint of hospital admission for right heart failure and cardiac mortality.…”

Section: To the Editormentioning

confidence: 99%

Letter by Kumar and Ahmad Regarding Article, “Prognostic Value of Complementary Echocardiography and Magnetic Resonance Imaging Quantitative Evaluation for Isolated Tricuspid Regurgitation”

Kumar

Ahmad

2022

Circ: Cardiovascular Imaging

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“…After correcting for potential confounders, RV-pulmonary artery uncoupling (defined as a ratio < 0.31 mm/mmHg) was the only echocardiographic parameter that was independently associated with all-cause mortality in patients with significant TR [55]. New measures of RV systolic function, quantified with CMR, including RV shortening and effective RVEF, have been shown to better identify patients with RV dysfunction and demonstrated incremental value over conventional RVEF when evaluating outcomes [56].…”

Section: Latest Developments In the Management Of Secondary Tricuspid...mentioning

confidence: 99%

Focus on Diagnosis and Prognosis to Guide Timing of Intervention in Valvular Heart Disease

et al. 2022

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Purpose of Review The present article reviews the role of multimodality imaging to improve risk stratification and timing of intervention in patients with valvular heart disease (VHD), and summarizes the latest developments in transcatheter valve interventions. Recent Findings Growing evidence suggests that intervention at an earlier stage may improve outcomes of patients with significant VHD. Multimodality imaging, including strain imaging and tissue characterization with cardiac magnetic resonance imaging, has the ability to identify early markers of myocardial damage and can help to optimize the timing of intervention. Transcatheter interventions play an increasing role in the treatment of patients who remain at high surgical risk or present at a late stage of their disease. Summary Multimodality imaging identifies markers of cardiac damage at an early stage in the development of VHD. Together with technological innovations in the field of percutaneous valvular devices, these developments have the potential to improve current management and outcomes of patients with significant VHD.

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Impact of right ventricular systolic function in patients with significant tricuspid regurgitation. A cardiac magnetic resonance study

Cited by 9 publications

References 30 publications

Basic pathophysiology and options of treatment for surgical management of functional tricuspid regurgitation: a systematic review

Basic pathophysiology and options of treatment for surgical management of functional tricuspid regurgitation: a systematic review

Letter by Kumar and Ahmad Regarding Article, “Prognostic Value of Complementary Echocardiography and Magnetic Resonance Imaging Quantitative Evaluation for Isolated Tricuspid Regurgitation”

Focus on Diagnosis and Prognosis to Guide Timing of Intervention in Valvular Heart Disease

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