Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair

Brener, Michael I.; Lurz, Philipp; Hausleiter, Jörg; Rodés‐Cabau, Josep; Fam, Neil; Kodali, Susheel; Rommel, Karl‐Philipp; Muntané‐Carol, Guillem; Gavazzoni, Mara; Nazif, Tamim; Pozzoli, Alberto; Alessandrini, Hannes; Latib, Azeem; Biasco, Luigi; Braun, Daniel; Brochet, Éric; Denti, Paolo; Lubos, Edith; Ludwig, Sebastian; Kalbacher, Daniel; Estévez‐Loureiro, Rodrigo; Connelly, Kim A.; Frerker, Christian; Ho, Edwin; Juliard, Jean‐Michel; Harr, Claudia; Moñivas, Vanessa; Nickenig, Georg; Pedrazzini, Giovanni; Philippon, François; Praz, Fabien; Puri, Rishi; Schöfer, Joachim; Sievert, Horst; Tang, Gilbert H.L.; Andreas, Martin; Thiele, Holger; Unterhuber, Matthias; Himbert, Dominique; Alcázar, Marina Ureña; Bardeleben, Ralph Stephan von; Windecker, Stephan; Wild, Mirjam G.; Maisano, Francesco; Leon, Martin B.; Taramasso, Maurizio; Hahn, Rebecca T.

doi:10.1016/j.jacc.2021.11.031

Cited by 113 publications

(59 citation statements)

References 26 publications

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“…Of note, correcting TR in patients with PAH or PH in (non-valvular) LHD with significantly elevated PVR and/or RV dysfunction must be considered with great caution, as this may be hazardous [704]. Right ventricle-PA coupling is an independent predictor of all-cause mortality in such patients [705]. Patient selection appears crucial, and a comprehensive diagnostic approach integrating imaging modalities and invasive haemodynamic assessment is necessary in the evaluation process prior to tricuspid valve repair, particularly since echocardiography underestimates sPAP in the presence of severe TR.…”

Section: Tricuspid Regurgitationmentioning

confidence: 99%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

788

1,631

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Section: Tricuspid Regurgitationmentioning

confidence: 99%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

788

1,631

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“…The ratio represents a robust hemodynamic marker associated with all-cause mortality in patients undergoing TV TEER [ 28 ]. An increase in the RV-PA coupling ratio may indicate an adequate ventricular and arterial response to TR reduction [ 29 ]. Reverse right ventricular remodelling results from reduced right ventricular size and increased functional indices, most likely due to the long-term effects of preload reduction after the initial period of afterload increase.…”

Section: Discussionmentioning

confidence: 99%

Edge-to-Edge Repair for Tricuspid Valve Regurgitation. Preliminary Echo-Data and Clinical Implications from the Tricuspid Regurgitation IMAging (TRIMA) Study

Carpenito

Cammalleri

Vitez

et al. 2022

JCM

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Background: The natural history of tricuspid valve regurgitation (TR) is characterized by poor prognosis and high in-hospital mortality when treated with isolated surgery. We report the preliminary echocardiographic and procedural results of a prospective cohort of symptomatic patients with high to prohibitive surgical risk and at least severe TR who underwent transcatheter edge-to-edge repair through the TriClipTM system. Methods: From June 2020 to March 2022, 27 consecutive patients were screened, and 13 underwent transcatheter TriClipTM repair. In-hospital, 30-day and six-month clinical and echocardiographic outcomes were collected. Results: Nine patients had severe, three massive and one baseline torrential TR. Sustained TR reduction of ≥1 grade was achieved in all patients, of which 90% reached a moderate TR or less. On transthoracic echocardiographic examination, there were significant reductions in vena contracta width (p < 0.001), effective regurgitant orifice area (p < 0.001) and regurgitant volume (p < 0.001) between baseline and hospital discharge. We also observed a significant reduction in tricuspid annulus diameter (p < 0.001), right ventricular basal diameter (p = 0.001) and right atrial area (p = 0.026). Conclusion: Treatment with the edge-to-edge TriClip device is safe and effective. The resulting echocardiographic improvements indicate tricuspid valve leaflet approximation does not just significantly reduce the grade of TR but also affects adjacent structures and improves right ventricular afterload adaptation.

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“…On the other hand, in decompensated states, RV contractile function does not rise together with the afterload, resulting in lower RV-PA coupling ratios. Brener et al ( 44 ) evaluated the prognostic value of non-invasively derived RV-PA coupling in patients from the TriValve registry undergoing TTVI for severe TR. A high baseline TAPSE/systolic pulmonary artery pressure (sPAP) ratio was found to be independently associated to lower all-cause mortality with respect to lower baseline TAPSE/sPAP ratios.…”

Section: Transcatheter Treatmentmentioning

confidence: 99%

Transcatheter and surgical treatment of tricuspid regurgitation: Predicting right ventricular decompensation and favorable responders

Sala

Beneduce²

2022

Front. Cardiovasc. Med.

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Isolated tricuspid regurgitation (TR) has gained increasing recognition in recent years both in the surgical and in the cardiological community. Left untreated, isolated TR significantly worsens survival. Despite being a strong predictor of negative prognosis, interventions to correct TR are rarely performed due to increased surgical risk and late patient presentation. Recently, the ultimate focus has been on patient selection, surgical or transcatheter indication, and correct timing. Furthermore, of paramount importance is the identification of predictors of outcome following treatment, in order to discriminate between favorable and unfavorable responders and guide the decision-making process of the most adequate treatment for every patient.

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Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair

Cited by 113 publications

References 26 publications

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Edge-to-Edge Repair for Tricuspid Valve Regurgitation. Preliminary Echo-Data and Clinical Implications from the Tricuspid Regurgitation IMAging (TRIMA) Study

Transcatheter and surgical treatment of tricuspid regurgitation: Predicting right ventricular decompensation and favorable responders

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