Invasive Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Edge-to-Edge Tricuspid Valve Repair

Stolz, Lukas; Weckbach, Ludwig T.; Karam, Nicole; Kalbacher, Daniel; Praz, Fabien; Lurz, Philipp; Omran, Hazem; Iliadis, Christos; Hausleiter, Jörg; Näbauer, Michael; Stocker, Thomas J.; Doldi, Philipp M.; Ludwig, Sebastian; Koell, Benedikt; Kassar, Mohammad; Besler, Christian; Unterhuber, Matthias; Rommel, Karl‐Philipp; Pfister, Roman; Eatemadi, Jennifer; Rudolph, Volker

doi:10.1016/j.jcmg.2022.10.004

Cited by 14 publications

(6 citation statements)

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“…This observation might help explain the consistent yet quantitatively only moderate prognostic value of TAPSE/PAPs ratios observed in prior studies and the limitations of the ratio to truly inform on RV/PA coupling. 26 Further reflecting on prognosis, it is essential to acknowledge the higher mortality rates observed in our study compared to the TRILUMINATE trial. 23 While this discrepancy may be partly attributed to the real-world, less controlled setting of our present registry, it could also be linked to more advanced LV diseases in our study, evidenced by twice the incidence of patients with a LV ejection fraction <50%.…”

Section: Discussionmentioning

confidence: 88%

“…Additionally, haemodynamic parameters, especially when invasively assessed, have proven to offer valuable prognostic information. This holds true, particularly for PA pressures, their pre‐capillary component, and their integration with RV function, termed RV/PA coupling 8,11,14,26,27 …”

Section: Discussionmentioning

confidence: 97%

“…This holds true, particularly for PA pressures, their pre-capillary component, and their integration with RV function, termed RV/PA coupling. 8,11,14,26,27 Somewhat surprisingly, despite the intricate interplay of biventricular filling pressures with pathological RV loading, pre-interventional levels of RAP or PCWP had not been linked to outcomes in patients undergoing TTVI until now. 8 Speculation arises that this might be attributed to substantial changes in RV loading conditions with TTVI, diminishing the predictive value of pre-interventional assessments.…”

Section: Discussionmentioning

confidence: 99%

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Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry

Rommel,

Bonnet,

Fortmeier

et al. 2024

European J of Heart Fail

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AimsWhile invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)‐related right‐ heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI.Methods and resultsWithin a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76–83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2‐year mortality on Cox regression analyses with Youden index‐derived cut‐offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre‐interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left‐sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right‐sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right‐sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates.ConclusionIn this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right‐sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre‐interventional reduction of right‐sided congestion can improve outcomes after TTVI should be established in dedicated studies.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry

Rommel,

Bonnet,

Fortmeier

et al. 2024

European J of Heart Fail

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“…The ratio between RV systolic function parameters and the Doppler-estimated pulmonary arterial systolic pressure (PASP) [TAPSE/PASP or RV free wall longitudinal strain (RVFWLS)/PASP] has been proposed as a surrogate for the invasively determined RV-pulmonary artery (PA) coupling. 59 Despite the limited accuracy of PASP estimation in massive/torrential STR characterized by a large effective regurgitant orifice area with low-flow velocity and rapid equalization of the RV and RA pressures, 60 , 61 TAPSE/PASP < 0.36 mm/mmHg and RVFWLS/PASP < −0.42%/mmHg have been associated with worse outcomes in medically treated patients with clinically relevant TR, 62 whilst TAPSE/PASP < 0.39–0.41 mm/mmHg was associated with increased mortality after TTVI. 61 , 63 A RV-PA coupling using TAPSE and invasively measured PASP (proposed cut-offs of <0.29–0.30 mm/mmHg) 60 , 61 improved the outcome prediction compared with the non-invasive TAPSE/PASP.…”

Section: Imaging Challenges and Practical Tips For Evaluating Patient...mentioning

confidence: 99%

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Muraru,

Badano,

Hahn

et al. 2024

European Heart Journal

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Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%–15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.

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“…The use of invasively measured sPAP in assessing RV-PA coupling may have additional predictive benefit. 63 Another estimate of RV-PA coupling is RV stroke volume indexed to RV end-systolic volume, whether measured by computed tomography 64 or by 3-dimensional echocardiography. 65 The latter method avoids the use of echocardiographic estimates of sPAP.…”

Section: Section 1: Disease State Considerationsmentioning

confidence: 99%

Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints

Hahn,

Lawlor,

Davidson

et al. 2023

European Heart Journal

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Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.

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Invasive Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Edge-to-Edge Tricuspid Valve Repair

Cited by 14 publications

References 4 publications

Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry

Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints

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