Tricuspid valve geometry and right heart remodelling: insights into the mechanism of atrial functional tricuspid regurgitation

2020 ◽  
Vol 21 (10) ◽  
pp. 1068-1078 ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Yu Harada ◽  
Hitoshi Susawa ◽  
Yusuke Ueda ◽  
Kanako Izumi ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Volume Ratio ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
Functional Tricuspid Regurgitation ◽  
End Systolic Volume ◽  
Tip Position

Abstract Aims  We sought to investigate tricuspid valve (TV) geometry and right heart remodelling in atrial functional tricuspid regurgitation (AF-TR) as compared with ventricular functional TR with sinus rhythm (VF-TR). Methods and results  Transoesophageal 3D echocardiography datasets of the TV and right ventricle were acquired in 51 symptomatic patients with severe TR (AF-TR, n = 23; VF-TR, n = 28). Three-dimensional right ventricular (RV) endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips. Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the centre of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z-axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P < 0.001). Additionally, the posteromedial-directed component of posterior PM tip position and the apically directed component of the position of all three PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P < 0.02). Conclusion  Right heart remodelling and its association with 3D TV geometry differ entirely between AF-TR and VF-TR, which may offer distinctive therapeutic implication.

Abstract 15424: Tricuspid Valve Geometry and Right Heart Remodeling: Insights Into the Mechanism of Atrial Functional Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Yu Harada ◽  
hitoshi susawa ◽  
Yusuke Ueda ◽  
Kanako Izumi ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
Therapeutic Implications ◽  
Heart Remodeling ◽  
Functional Tricuspid Regurgitation ◽  
End Systolic Volume

Introduction: Functional tricuspid regurgitation (TR) caused by chronic atrial fibrillation with structurally normal tricuspid valve (TV) leaflets, normal right ventricular (RV) function, and dilated right atrium (RA), is considered as a new clinical entity, atrial functional TR (AF-TR). We sought to investigate TV geometry and right heart remodeling in AF-TR compared with ventricular functional TR with sinus rhythm (VF-TR). Methods: Transesophageal 3D echocardiography datasets of the TV and the RV were acquired in 51 symptomatic severe TR. 3D RV endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips (Figure). Results: Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the center of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P <0.001). Additionally, the posteromedial directed component of posterior PM tip position and the apically directed component of the position of all 3 PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P <0.02). In subgroup analysis, massive to torrential AF-TR had a larger RV volume with more apically displaced PM tips than severe AF-TR. Conclusion: Right heart remodeling and its association with TV geometry differ between AF-TR and VF-TR, which offers distinctive therapeutic implications.

scholarly journals Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

2021 ◽  
Author(s):  
Marijana Tadic ◽  
Cesare Cuspidi ◽  
Daniel Armando Morris ◽  
Wolfang Rottbauer
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Functional Mitral Regurgitation ◽  
Tricuspid Valve Repair ◽  
Right Heart ◽  
Heart Remodeling ◽  
Functional Tricuspid Regurgitation ◽  
Patients With Heart Failure

AbstractSignificant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.

Heart valve disease: tricuspid valve disease

2016 ◽  
Author(s):  
Denisa Muraru ◽  
Ashraf M. Anwar ◽  
Jae-Kwan Song
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Functional Tricuspid Regurgitation ◽  
Valve Pathology ◽  
Three Dimensional Echocardiography ◽  
The Right

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

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 &lt; 0.001 for all). The RA was significantly enlarged in both A-FTR and V-FTR compared to controls (P &lt; 0.001, Z-scores &gt; 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 Sleep disordered breathing and enlargement of the right heart after myocardial infarction

2014 ◽  
Vol 45 (3) ◽  
pp. 680-690 ◽  
Author(s):  
Stefan Buchner ◽  
Michael Eglseer ◽  
Kurt Debl ◽  
Andrea Hetzenecker ◽  
Andreas Luchner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Sleep Disordered Breathing ◽  
Left Ventricular ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
The Right

Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3–5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea–hypopnoea index of ≥15 events·h−1.12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27)versusthose without (n=25) (mean±sd14±23%versus0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea–hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013–0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm2versus1.0±2.4 cm2, p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI.

scholarly journals 145 Prognostic value of three-dimensional echocardiographic assessment of tricuspid valve geometry in atrial and ventricular functional tricuspid regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Heilbron ◽  
Mara Gavazzoni ◽  
Diana Florescu ◽  
Roberto Ochoa ◽  
Michele Tomaselli ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Major Axis ◽  
Right Atrial ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
History Of ◽  
The Difference

Abstract Aims Atrial and ventricular functional tricuspid regurgitation (A-FTR and V-FTR) have recently emerged as different phenotypes of FTR. Given the difference in mechanisms that are postulated to be underlying these two entities, a different remodelling of tricuspid valve (TV) apparatus can occur and therefore also a specific quantitative approach could be deemed. Moreover, considered the known limitation of the two-dimensional flow convergence method (2D-PISA) for quantifying FTR in advanced valve apparatus remodelling with irregular effective valve orifice (ERO) morphology, it would be expected that also the parameters of severity of FTR can be different in these two types of FTR. The aim of this study was to investigate the TV apparatus remodelling in the two different phenotypes of FTR: ventricular (V-FTR) and atrial (A-FTR) and the role of echocardiographic parameters of TV remodelling and TR severity to predict clinical outcomes. Methods and results The present retrospective study included consecutive patients with moderate to severe functional tricuspid regurgitation (FTR) referred for echocardiography in two Italian centres. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis. According to more recent guidelines, patients were considered having A-FTR if having history of long-standing atrial fibrillation, without history of pulmonary hypertension and left side heart disease. A total of 180 patients were included. Despite the right atrial volume (RAV) was not different in the two groups, in A-FTR tethering height was significantly lower (11.7 ± 4.8 mm vs. 15.0 ± 5.5 in V-FTR. P &lt; 0.01) and the 3D-derived tricuspid annulus (TA) diameters were larger both in end-diastolic and mid-systolic phase (3D-TA-End diastolic-major axis: 45.2 ± 6.2 mm in A-FTR vs. 42.8 ± 5.4 in V-FTR. P = 0.04; 3D-TA mid systolic major axis: 41.7 ± 6.4 mm in A-FTR vs. 37.9 ± 5.1 in V-FTR, P &lt; 0.01). 3D-TA-End diastolic-minor axis: 39.7 ± 6.8 vs. 37.1 ± 5.2. P = 0.03. Regarding the parameters of severity of FTR, patients with V-FTR had larger vena contracta (VC), either when 2D estimated or 3D (2D-VC-average: 5.3 ± 2.8 mm in A-FTR vs. 6.6 ± 3.7 in V-FTR. P = 0.02; 3D-VCA: 0.9 ± 0.4 cm2 vs. 1.3 ± 1.1 cm2, P = 0.02); conversely the value of 2D-ERO and regurgitant volume estimated with 2D-PISA method did not show significant difference between the two groups. After a median follow-up of 24 months (IQR: 2–48) 72 patients (40%) reached the primary endpoint and 64 (36%) hospitalized for HF. Different predictors of combined endpoint were found in the two groups: tenting height. 2D-VC. 3D-VCA and regurgitant fraction were prognostic correlates in V-FTR; TA dimensions as well as all the parameters of severe TR, including EROA with PISA method were related to the prognosis in A-FTR. Conclusions Different TV remodelling occurs in patients with A- and V-FTR, having the second more pronounce tethering of TV leaflets; the prognostic role of quantitative parameters of FTR in these two groups is different, thus reaffirming: (1) the limitation of PISA method without correction in case of more pronounced tenting of leaflets; (2) the difference in underlying pathogenic mechanisms; and (3) the needing for a more specific diagnostic approach and prognostic stratification in these two FTR phenotypes.

scholarly journals P764 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Previtero ◽  
A C Guta ◽  
R C Ochoa-Jimenez ◽  
C Palermo ◽  
D Bottigliengo ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Predictive Ability ◽  
Important Predictor ◽  
Basal Diameter ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Chamber View ◽  
Functional Tricuspid Regurgitation ◽  
Three Dimensional Echocardiography

Abstract Background According to current EACVI guidelines, right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified. Purpose Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR. Methods 302 patients (59 ± 13 years, 54 % women) with functional TR underwent two- and three-dimensional echocardiography. Using the nonparameteric Variable Importance (VIMP) software package, we assessed the relative importance of 6 differerent parameters (indexed by body surface area) to identify severe TR: 3D RV end diastolic volume (RVEDVi), 3D RV end systolic volume (RVESVi), 3D RA max volume (3DRAi), 2D RA systolic volume (3DRAi), 2D RV basal diameter (2DRVdi) and 2D TAi measured in the apical 4-chamber view. Results According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= -0.0011 and RVESVi= -0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2D TAi (VIMP= 0.004) showed good predictive ability. Conclusions Among the various right heart structures undergoing remodeling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR.

Familial cardiomyopathies

2016 ◽  
Author(s):  
Fausto Rigo ◽  
Covadonga Fernández-Golfín ◽  
Bruno Pinamonti
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Functional Tricuspid Regurgitation ◽  
Dimensional Echocardiography ◽  
Valve Pathology ◽  
Three Dimensional Echocardiography ◽  
The Right ◽  
Valve Diseases

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

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