Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair

Stolz, Lukas; Doldi, Philipp M.; Weckbach, Ludwig T.; Stocker, Thomas J.; Braun, Daniel; Orban, Martin; Wild, Mirjam G.; Hagl, Christian; Maßberg, Steffen; Näbauer, Michael; Hausleiter, Jörg; Orban, Mathias

doi:10.3389/fcvm.2022.993618

Cited by 4 publications

(2 citation statements)

References 53 publications

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“…The normal tricuspid annulus is a dynamic, non-planar, oval, saddle-shaped fibrous component of the tricuspid valve apparatus, which is considered a component of the right ventricle [13]. The shape and size of the tricuspid annulus highly depend on loading conditions, as the fibrous annulus is incomplete at the RV-free wall region, allowing potential dilatation at this location [17,27]. The anterior papillary muscle supports the chordae of the anterior and posterior leaflet, while the posterior papillary muscle supports the chordae of the posterior and septal leaflet.…”

Section: Anatomy and Physiology Of The Right Ventricle And Tricuspid ...mentioning

confidence: 99%

“…The tricuspid annulus The anterior localization of the tricuspid annulus in the mediastinum makes its visualization acceptable by transthoracic echocardiography. The tricuspid annulus consists of fibrous tissue, which is sensitive to preload, afterload, and right ventricular and atrial dilatation [13,27]. The normal diameter of tricuspid annulus in adults is 28 ± 5 mm by 2D-echocardiography measured from apical four-chamber view [73].…”

Section: Two-dimensional Echocardiography Of the Right Ventricle And ...mentioning

confidence: 99%

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Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

2023

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Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.

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Section: Anatomy and Physiology Of The Right Ventricle And Tricuspid ...mentioning

confidence: 99%

Section: Two-dimensional Echocardiography Of the Right Ventricle And ...mentioning

confidence: 99%

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

2023

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Residual tricuspid regurgitation after tricuspid transcatheter edge‐to‐edge repair: Insights into the EuroTR registry

Stolz,

Kresoja,

von Stein

et al. 2024

European J of Heart Fail

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AimsData on the prognostic impact of residual tricuspid regurgitation (TR) after tricuspid transcatheter edge‐to‐edge repair (T‐TEER) are scarce. The aim of this analysis was to evaluate 2‐year survival and symptomatic outcomes of patients in relation to residual TR after T‐TEER.Methods and resultsUsing the large European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR registry) we investigated the impact of residual TR on 2‐year all‐cause mortality and New York Heart Association (NYHA) functional class at follow‐up. The study further identified predictors for residual TR ≥3+ using a logistic regression model. The study included a total of 1286 T‐TEER patients (mean age 78.0 ± 8.9 years, 53.6% female). TR was successfully reduced to ≤1+ in 42.4%, 2+ in 40.0% and 3+ in 14.9% of patients at discharge, while 2.8% remained with TR ≥4+ after the procedure. Residual TR ≥3+ was an independent multivariable predictor of 2‐year all‐cause mortality (hazard ratio 2.06, 95% confidence interval 1.30–3.26, p = 0.002). The prevalence of residual TR ≥3+ was four times higher in patients with higher baseline TR (vena contracta >11.1 mm) and more severe tricuspid valve tenting (tenting area >1.92 cm2). Of note, no survival difference was observed in patients with residual TR ≤1+ versus 2+ (76.2% vs. 73.1%, p = 0.461). The rate of NYHA functional class ≥III at follow‐up was significantly higher in patients with residual TR ≥3+ (52.4% vs. 40.5%, p < 0.001). Of note, the degree of TR reduction significantly correlated with the extent of symptomatic improvement (p = 0.012).ConclusionsT‐TEER effectively reduced TR severity in the majority of patients. While residual TR ≥3+ was associated with worse outcomes, no differences were observed for residual TR 1+ versus 2+. Symptomatic improvement correlated with the degree of TR reduction.

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Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI

Steffen,

Lux,

Stocker

et al. 2024

Clin Res Cardiol

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Background Right ventricular (RV) dysfunction in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) has long been disregarded. We aimed to assess the predictive value of RV to pulmonary artery coupling (RV/PAc), defined as tricuspid annular plane systolic excursion to systolic pulmonary artery pressure, on mortality in different flow types of AS after TAVI. Methods All patients undergoing TAVI for AS at our centre between 2018 and 2020 were assessed; 862 patients were analysed. The cohort was dichotomized using a ROC analysis (cut-off 0.512 mm/mmHg), into 429 patients with preserved and 433 patients with reduced RV/PAc. Results Reduced RV/PAc was associated with male sex and a higher rate of comorbidities. Short-term VARC-3 endpoints and NYHA classes at follow-up were comparable. Reduced RV/PAc was associated with higher 2-year all-cause mortality (35.0% [30.3–39.3%] vs. 15.4% [11.9–18.7%], hazard ratio 2.5 [1.9–3.4], p < 0.001). Cardiovascular mortality was almost tripled. Results were consistent after statistical adjustment and in a multivariate model. Sub-analyses of AS flow types revealed lower RV/PAc in classical and paradoxical low-flow low-gradient AS, with the majority having reduced RV/PAc (74% and 59%). RV/PAc retained its predictive value in these subgroups. Conclusions RV dysfunction defined by low RV/PAc is a strong mortality predictor after TAVI independent of flow group. It should be incorporated in future TAVI risk assessment. Graphical abstract

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Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair

Cited by 4 publications

References 53 publications

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

Residual tricuspid regurgitation after tricuspid transcatheter edge‐to‐edge repair: Insights into the EuroTR registry

Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI

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