Is Isolated tricuspid regurgitation different from functional tricuspid regurgitation?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Vieitez Florez ◽  
J.M Monteagudo ◽  
P Mahia ◽  
I Marco ◽  
T Gonzalez ◽  
...  
Keyword(s):  
Prospective Study ◽  
Tricuspid Regurgitation ◽  
Functional Class ◽  
Tricuspid Annulus ◽  
Large Prospective Study ◽  
Functional Tricuspid Regurgitation ◽  
Echocardiographic Study ◽  
Rv Function ◽  
Worse Prognosis ◽  
Annulus Diameter

Abstract Introduction Isolated tricuspid regurgitation (TR) prevalence is increasing in the last decades. Its presence is associated with a worse prognosis when EROA is >40 mm2. Because of high surgery risk and increasing incidence, isolated TR is a challenge in modern cardiology. Purpose To evaluate the prevalence and characteristics of isolated TR compared to other TR aetiologies in a large cohort of patients. Methods Prospective study where consecutive patients undergoing an echocardiographic study within a three-month period were included. All studies with at least moderate TR were selected. Isolated TR was defined as TR with no likely pulmonary hypertension (>50 mmHg), no overt TR cause (no intrinsic tricuspid disease, LVEF ≥50%, no pacemaker/defibrillator wire across the tricuspid, no other significant valve disease, no disease that may cause TR, no congenital or pericardial heart disease); and no previous valve surgery. Patients with isolated TR and other aetiologies were compared. Results 2121 patients with at least moderate TR were included. Isolated TR was found in 398 patients (18.8%). Basal characteristics are shown in table 1. Patients with isolated TR did not have a higher prevalence of AF (47.5% vs. 48.6% p=0.362). Isolated TR was less severe (20.5% vs. 32.1% of patients with severe TR; p<0.001) and less symptomatic (NYHA ≥ II in 27.8% of patients vs. 69.3%; p<0.001). After selecting patients with at least severe TR, patients with isolated TR were also less symptomatic (NYHA≥II in 47.8% of patients vs. 70.7%; p<0.001) and they had better RV function (TAPSE <17 mm in 13.4% vs. 35.6%; p=0.001). We found that patients with isolated severe TR had a larger tricuspid annulus diameter (25.4±0.8 mm/m2 vs. 24.0±0.3 mm/m2; p=0.047). Conclusions In this large prospective study, isolated TR is present in 18.8% of significant TR. Isolated TR was less severe, was associated with less RV dilatation (but with larger tricuspid annulus diameter) and patients had a better functional class compared to other TR aetiologies. Differeces in NYHA and RV function Funding Acknowledgement Type of funding source: None

scholarly journals 39 Overview of tricuspid regurgitation (tr). new classification of tr. when severe tr is too severe?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J M Vieitez Florez ◽  
J M Monteagudo ◽  
P Mahia ◽  
L Perez ◽  
T Lopez ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Treatment Strategies ◽  
Moderate Degree ◽  
New Classification ◽  
Basal Diameter ◽  
Usual Practice ◽  
Echocardiographic Study ◽  
Rv Function ◽  
Worse Prognosis

Abstract Introduction Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, it is not know how many of the patients classified as severe TR, corresponds to the new Torrential or massive classification that for sure will lead to different treatment strategies. Also few published studies have addressed the aetiologies, mechanisms and severity in large cohorts. Purpose To evaluate the burden of TR in a large cohort of patients referred for an echocardiography. Methods Prospective study where consecutive patients undergoing an echocardiographic study in 10 Spanish hospitals within a three-month period were included. All studies with at least moderate TR were selected for analysis. The evaluation was conduced according to the usual practice of the laboratory. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR was quantified according to Hanh & Zamorano new published classification. Results A total of 35088 consecutive echocardiographic studies were performed in the participant hospitals during the recruitment period. TR of at least moderate degree was detected in 2124 studies (6,05%). Mean age was 77,1 years and 62.8% were women. Mitral or aortic valvulopthy was the most common cause, present in almost half of cases (48.4%). The second cause of TR was idiopathic with 22.2% of cases. Primary TR was found in 7.2% of patients, the most frequent aetiology in these group was cardiac implantable devices with 4.2% of total of TR. Aetiology and severity according to the new classification can be seen in the figures Atrial fibrillation was present in 47.6% of cases. 56.4% of patients had symptoms at the time of the study (NYHA≥2 at the time of study). Right ventricle (RV) was dilated (telediastolic basal diameter >42mm) in 39.4% of patients). RV function was impared (TAPSE <17mm) in 30.6% of patients. Conclusions In these larger multicentre study, significant TR may is present in up to 6% of the echocardiographic studies and is often symptomatic[m1] . 4,91% of patients had a massive or torrential grade. Most TR are secondary to mitral or aortic valvulopathy. Idiopathic TR has taken the second place. Abstract 39 Figure. Severity and aetiology of TR

scholarly journals 319 Right heart chambers geometry and function in patients with the atrial and the ventricular phenotypes of functional tricuspid regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Diana Ruxandra Florescu ◽  
Denisa Muraru ◽  
Cristina Florescu ◽  
Mara Gavazzoni ◽  
Valentina Volpato ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Systolic Function ◽  
Three Dimensional ◽  
Right Heart ◽  
Maximal Volume ◽  
Functional Tricuspid Regurgitation ◽  
Permanent Atrial Fibrillation ◽  
Z Scores ◽  
And Function ◽  
Rv Function

Abstract Aims Atrial functional tricuspid regurgitation (A-FTR) is a recently defined phenotype of FTR associated with persistent/permanent atrial fibrillation. Differently from the classical ventricular form of FTR (V-FTR), patients with A-FTR might present with severely dilated right atrium (RA) and tricuspid annulus (TA), and with preserved right ventricular (RV) size and systolic function. However, the geometry and function of the RV, RA, and TA in patients with A-FTR and V-FTR remain to be systematically evaluated. Accordingly, we sought to: (i) study the geometry and function of the RV, RA, and TA in A-FTR by two- and three-dimensional transthoracic echocardiography and (ii) compare them with those found in V-FTR. Methods and results We prospectively analysed 113 (44 men, age 68 ± 18 years) FTR patients (A-FTR = 55 and V-FTR = 58) that were compared to two groups of age- and sex-matched controls to develop the respective Z-scores. Severity of FTR was similar in A-FTR and V-FTR patients. Z-scores of RV size were significantly larger, and those of RV function were significantly lower in V-FTR than in A-FTR (P < 0.001 for all). The RA was significantly enlarged in both A-FTR and V-FTR compared to controls (P < 0.001, Z-scores > 2), with similar RA maximal volume (RAVmax) between A-FTR and V-FTR (P = 0.2). Whereas, the RA minimal volumes (RAVmin) were significantly larger in A-FTR than in V-FTR (P = 0.001). Conclusions Despite similar degrees of FTR, and RAVmax size, A-FTR patients show a larger RAVmin, and smaller TA areas than V-FTR patients. Conversely, V-FTR patients show dilated, more elliptic, and dysfunctional RV than A-FTR patients.

scholarly journals Characteristics of idiopathic tricuspid regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
LWY Li ◽  
MS Huang ◽  
WH Lee ◽  
WC Tsai
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Systemic Approach ◽  
Left Heart ◽  
Tricuspid Annulus ◽  
Left Heart Disease ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan Background Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics. Methods 207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step. Results There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR. Conclusions Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.

Evolution of Tricuspid Regurgitation after Mitral Valve Surgery for Patients with Moderate-or-Less Functional Tricuspid Regurgitation

2012 ◽  
Vol 15 (3) ◽  
pp. 121 ◽  
Author(s):  
Kai-hu Shi ◽  
Hai-yang Xuan ◽  
Fei Zhang ◽  
Sheng-song Xu ◽  
Jun-xu Wu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Mitral Valve ◽  
Postoperative Period ◽  
Tricuspid Regurgitation ◽  
Mitral Valve Surgery ◽  
Tricuspid Annulus ◽  
Lower Survival ◽  
Functional Tricuspid Regurgitation ◽  
The Impact

<p><b>Objectives:</b> The purpose of this study was to evaluate the impact of moderate-or-less functional tricuspid regurgitation (TR) treatment on the clinical outcome of patients with mitral valve (MV) surgery.</p><p><b>Methods:</b> From October 2001 to January 2005, 167 patients in our hospital with MV surgery and without organic tricuspid valve (TV) disease or pulmonary hypertension (PH) showed moderate-or-less functional TR preoperatively, and 41.9% of these patients were treated with TR (group T), compared with 58.1% untreated with TR (group no-T). According to tricuspid annulus dimension (TAD)/body surface area (BSA), these 167 patients were further divided into another 2 groups (A and B): group A (70 patients) represented TAD/BSA ? 21 mm/m2 with 32 patients from group T and 38 from group no-T, and group B (97 patients) represented TAD/BSA > 21 mm/m2 with 38 patients from group T and 59 patients from group no-T. There was no statistical difference in preoperative and operative variables between the 2 groups. Meanwhile, among the 167 patients with MV surgery, 157 patients were replaced with MV and 10 patients were repaired with MV, and De Vega technique was constantly used for TR treatment. All the results were estimated by multivariate analysis.</p><p>Results: The median follow-up time was 63 months (25th and 75th percentiles are 53 and 94 months, respectively); 30-day mortality was 3% (1.4% in group T versus 4.1% in group no-T; <i>P</i> = .31). Adjusted 5-year survival was 70.7% (66.6%-80.4%) with 85.3% (83.0%-93.4%) in group T and 64.7% (33.7%-58.3%) in group no-T, <i>P</i> = .001. Among the 70 patients with TAD/BSA ? 21 mm/m2, patients who received treatment of moderate-or-less TR and those who did not showed similar secondary TR grade at postoperative period (0.5 � 0.6 in group T versus 0.9 � 0.9 in group no-T; <i>P</i> = .2) and follow-up (1.3 � 1.1 in group T versus 1.8 � 1.1 in group no-T; <i>P</i> = .06). In subgroup B (TAD/BSA > 21 mm/m2), patients who received tricuspid valvoplasty manifested more significantly improved outcome than patients without functional TR at postoperative period (0.8 � 0.8 in group T versus 1.6 � 1.3 in group no-T; <i>P</i> = .03) and follow-up (2.0 � 1.2 in group T versus 3.0 � 1.1 in group no-T; <i>P</i> = .005). The multivariate analysis identified TAD/BSA > 21 mm/m2 and preoperative atrial fibrillation (AF) as the risk factors for lower survival at follow-up period.</p><p>Conclusions: Patients with MV surgery have better midterm outcome when they receive either more aggressive and effective surgical treatment for functional TR or moderate-or-less TR preoperatively. Indexed TAD (TAD/BSA > 21 mm/m2) is a more reliable surgical guideline for the treatment of TR. Preoperative tricuspid annulus dilation and AF might be predictors of late lower survival.</p>

scholarly journals Right atrial volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation: a three-dimensional echocardiographic study

2020 ◽  
Author(s):  
Denisa Muraru ◽  
Karima Addetia ◽  
Andrada C Guta ◽  
Roberto C Ochoa-Jimenez ◽  
Davide Genovese ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Major Determinant ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Tricuspid Annulus ◽  
Maximal Volume ◽  
Ventricular Ejection Fraction ◽  
Functional Tricuspid Regurgitation

Abstract Aims The aim of this study is to explore the relationships of tricuspid annulus area (TAA) with right atrial maximal volume (RAVmax) and right ventricular end-diastolic volume (RVEDV) in healthy subjects and patients with functional tricuspid regurgitation (FTR) of different aetiologies and severities. Methods and results We enrolled 280 patients (median age 66 years, 59% women) with FTR due to left heart disease (LHD), pulmonary hypertension (PH), corrected tetralogy of Fallot (TOF), chronic atrial fibrillation (AF), and 210 healthy volunteers (45 years, 53% women). We measured TAA at mid-systole and end-diastole, tenting volume of tricuspid leaflets, RAVmax, and RVEDV by 3D echocardiography. Irrespective of TA measurement timing, TAA correlated more closely with RAVmax than with RVEDV in both controls and FTR patients. On multivariable analysis, RAVmax was the most important determinant of TAA, accounting for 41% (normals) and 56% (FTR) of TAA variance. In FTR patients, age, RVEDV, and left ventricular ejection fraction were also independently correlated with TAA. RAVmax (AUC = 0.81) and TAA (AUC = 0.78) had a greater ability than RVEDV (AUC = 0.72) to predict severe FTR (P &lt; 0.05). Among FTR patients, those with AF had the largest RAVmax and smallest RVEDV. RAVmax and TA were significantly dilated in all FTR groups, except in TOF. PH and TOF had largest RVEDV, yet tenting volume was increased only in PH and LHD. Conclusion RA volume is a major determinant of TAA, and RA enlargement is an important mechanism of TA dilation in FTR irrespective of cardiac rhythm and RV loading conditions.

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