Natural History of Functional Tricuspid Regurgitation

Bartko, Philipp E.; Arfsten, Henrike; Frey, Maria Klara; Heitzinger, Gregor; Pávó, Noémi; Cho, Anna; Neuhold, Stephanie; Tan, Timothy C.; Strunk, Guido; Hengstenberg, Christian; Hülsmann, Martin; Goliasch, Georg

doi:10.1016/j.jcmg.2018.11.021

Cited by 114 publications

(46 citation statements)

References 20 publications

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“…Numerous studies have shown that reduced RVF is associated with worse prognosis in severe TR [ 15 , 16 ]. However, it still remains unclear if the same lower limits of normality apply for each of the parameters as in patients without TR.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Schneider

König

Geller

et al. 2021

JCM

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Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Schneider

König

Geller

et al. 2021

JCM

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“…Whether these studies enforce the call for an early intervention is still unclear. In particular, the results provided by Neuhold et al ( 70 ) and Bartko et al ( 71 ) remind us the need for a careful clinical and echocardiographic evaluation of the severity of both HF, and TR before any decision-making: in fact, tricuspid surgery can be done with low-mortality rates only if it is performed before advanced HF stage ( 75 ), and we may even not expect the same benefits from percutaneous treatment across all the cohort of these patients.…”

Section: The Prognostic Impact Of Tr: a Reappraisalmentioning

confidence: 91%

“…Bartko et al ( 71 ) sought to define the natural history of FTR and the prognostic value of its recommended echocardiographic quantification among 372 patients with HF and LVSD. While they confirmed that the severity of FTR increased along with NYHA class ( p = 0.005) and NT-proBNP levels ( p < 0.001), surprisingly the thresholds of TR quantitative parameters associated with an increased mortality ( p < 0.001) were congruent with moderate TR as defined by the present guidelines ( 73 ): EROA > 0.2 cm 2 , vena contracta > 5 mm and regurgitant volume >20 ml.…”

Section: The Prognostic Impact Of Tr: a Reappraisalmentioning

confidence: 99%

Tricuspid Regurgitation in Left Ventricular Systolic Dysfunction: Marker or Target?

Margonato

Ancona

Ingallina

et al. 2021

Front. Cardiovasc. Med.

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Far from being historically considered a primary healthcare problem, tricuspid regurgitation (TR) has recently gained much attention from the scientific community. In fact, in the last years, robust evidence has emerged regarding the epidemiological impact of TR, whose prevalence seems to be similar to that of other valvulopathies, such as aortic stenosis, with an estimated up to 4% of people >75 years affected by at least moderate TR in the United States, and up to 23% among patients suffering from heart failure with reduced ejection fraction. This recurrent coexistence of left ventricular systolic dysfunction (LVSD) and TR is not surprising, considered the multiple etiologies of tricuspid valve disease. TR can complicate heart failure mostly as a functional disease, because of pulmonary hypertension (PH), subsequent to elevated left ventricular end-diastolic pressure, leading to right ventricular dilatation, and valve tethering. Moreover, the so-called “functional isolated” TR can occur, in the absence of PH, as a result of right atrial dilatation associated with atrial fibrillation, a common finding in patients with LVSD. Finally, TR can result as a iatrogenic consequence of transvalvular lead insertion, another frequent scenario in this cohort of patients. Nonetheless, despite the significant coincidence of these two conditions, their mutual relation, and the independent prognostic role of TR is still a matter of debate. Whether significant TR is just a marker for advanced left-heart disease, or a crucial potential therapeutical target, remains unclear. Aim of the authors in this review is to present an update concerning the epidemiological features and the clinical burden of TR in the context of LVSD, its prognostic value, and the potential benefit for early tricuspid intervention in patients affected by contemporary TR and LVSD.

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“…The tricuspid diastolic SV may be overestimated in case of heterogeneous and complex annular flow patterns (54). Despite interobserver variability, the volume derived from quantitative Doppler assessment correlates well with other echocardiographic parameters (56) and has a prognostic value in patients with TR and reduced left ventricular function (8).…”

Section: Regurgitant Volumementioning

confidence: 96%

“…Multiple observational studies have reported worse survival in patients with severe TR, irrespective of left and right ventricular function, pulmonary artery pressure, age, gender and co-morbidities (2,(5)(6)(7)(8)(9)(10). In patients undergoing left-sided heart valve surgery or interventional treatment, the presence of relevant TR has been identified as a predictor of poor outcomes (11,12).…”

Section: Introductionmentioning

confidence: 99%

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Winkel

Brugger

Khalique

et al. 2020

Front. Cardiovasc. Med.

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With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.

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Natural History of Functional Tricuspid Regurgitation

Cited by 114 publications

References 20 publications

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Tricuspid Regurgitation in Left Ventricular Systolic Dysfunction: Marker or Target?

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

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