Right ventricular dp/dt/pmax, not dp/dtmax, noninvasively derived from tricuspid regurgitation velocity is a useful index of right ventricular contractility

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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Right ventricular longitudinal strain predicts survival in patients with functional tricuspid regurgitation

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.01.006 ◽

2021 ◽

Author(s):

M. Bannehr ◽

U. Kahn ◽

J. Liebchen ◽

M. Okamoto ◽

V. Hähnel ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Longitudinal Strain ◽

Functional Tricuspid Regurgitation

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RIGHT VENTRICULAR SIZE MODIFIES THE EFFECT OF TRICUSPID REGURGITATION ON SURVIVAL IN OLDER AGED ADULTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03058-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1702

Author(s):

Jordan B. Strom ◽

Ariane Fraiche ◽

Jiaman Xu ◽

Lawrence J. Markson ◽

Connie Tsao ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Ventricular Size ◽

Right Ventricular Size

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Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Clinical Research in Cardiology ◽

10.1007/s00392-021-01812-3 ◽

2021 ◽

Author(s):

Martin Riesenhuber ◽

Andreas Spannbauer ◽

Marianne Gwechenberger ◽

Thomas Pezawas ◽

Christoph Schukro ◽

...

Keyword(s):

Mitral Regurgitation ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Ventricular Dilatation ◽

Pacemaker Lead ◽

Survival Analyses ◽

Before And After ◽

Right Ventricular Dilatation ◽

Survival Predictors

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

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

Journal of Clinical Medicine ◽

10.3390/jcm10112266 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2266

Author(s):

Matthias Schneider ◽

Varius Dannenberg ◽

Andreas König ◽

Welf Geller ◽

Thomas Binder ◽

...

Keyword(s):

Right Ventricular ◽

Ventricular Function ◽

Tricuspid Regurgitation ◽

Right Ventricular Function ◽

Prognostic Value ◽

Large Scale ◽

Systolic Function ◽

Left Ventricular ◽

Severe Tricuspid Regurgitation ◽

Vena Contracta

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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