Tricuspid regurgitation in ischemic mitral regurgitation patients – prevalence, predictors for outcome and long-term follow-up

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was five years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N=40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7±9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3±6.45 [%], LA area 46.4±8.06 [mm2], LV internal diastolic diameter (LVIDD) 59.6±3.94 [mm], RV fractional area change (RVFAC) 22.3±4.36 [%], systolic pulmonary artery pressure (SPAP) 48.4±9.45 [mmHg]. Independent variables associated with FTR development were age ≥65y [OR 1.2], failed revascularization, LA area ≥42.5 [mm2] [OR 17.1], LVEF ≤24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p=0.06 and p=0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up. FUNDunding Acknowledgement Type of funding sources: None.

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Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01982-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ofir Koren ◽

Henda Darawsha ◽

Ehud Rozner ◽

Daniel Benhamou ◽

Yoav Turgeman

Keyword(s):

Cohort Study ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Tricuspid Regurgitation ◽

Ischemic Mitral Regurgitation ◽

Lv Ejection Fraction ◽

Severe Grade

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was 5 years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N = 40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7 ± 9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3 ± 6.45 [%], LA area 46.4 ± 8.06 (mm2), LV internal diastolic diameter (LVIDD) 59.6 ± 3.94 (mm), RV fractional area change 22.3 ± 4.36 (%), systolic pulmonary artery pressure (SPAP) 48.4 ± 9.45 (mmHg). Independent variables associated with FTR development were age ≥ 65y [OR 1.2], failed revascularization, LA area ≥ 42.5 (mm2) [OR 17.1], LVEF ≤ 24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p = 0.06 and p = 0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.

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Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

Cardiology in the Young ◽

10.1017/s104795112100161x ◽

2021 ◽

pp. 1-6

Author(s):

Tong Feng ◽

Guo Zhangke ◽

Bai Song ◽

Fan Fan ◽

Zhen Jia ◽

...

Keyword(s):

Coronary Artery ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Surgical Repair ◽

Left Ventricular ◽

Anomalous Origin ◽

Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

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481Right ventricular longitudinal strain predicts symptoms in patients with chronic primary mitral regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehz747.0131 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A L Chilingaryan ◽

L G Tunyan ◽

K G Adamyan

Keyword(s):

Mitral Regurgitation ◽

Ejection Fraction ◽

Left Atrial ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Volume Index ◽

Asymptomatic Patients ◽

Lv Ejection Fraction ◽

Primary Mitral Regurgitation

Abstract Mitral regurgitation (MR) leads to subclinical changes that often cannot be detected by low sensitive conventional parameters and early predictors of deterioration could suggest a better timing for intervention. Methods We follow up 175 asymptomatic patients 56±13 years (79 female) with severe primary MR in sinus rhythm and without diabetes mellitus and renal disease for 2 years. Global longitudinal strain (LS) of left ventricle (LVGLS), right ventricular (RV) free wall LS (RVLS), and left atrial (LA) peak reservoir LS as average of two basal segments in 4 chamber view were measured by speckle tracking along with indexes of LV end-systolic and end-diastolic volumes, LV ejection fraction (EF), left atrial end-systolic volume index (LAVi) every 6 months. Normal reference values of LS were obtained from age and sex matched 40 healthy controls. Results Patients with MR had higher LV ejection fraction (EF), LVGLS, LALS and lower values of RVLS compared with controls (EF 67.4±5% vs 59.3±4%, p<0.05; LVGLS –25.2±2.3% vs –21.2±1.9%, p<0.03; LALS 46.2±5.1% vs 42.4±3.7%, p<0.04; RVLS –23.4±5.1% vs –27.3±2.8%, p<0.03). 53 (30%) patients developed symptoms at exercise during follow up. Symptomatic patients at baseline had higher values of RVLS compared with patients who remained asymptomatic during follow up without significant differences in EF, LVGLS, LALS (RVLS –21.4±2.6% vs –25.8±3.2%, p<0.02; EF 66.8±2.4% vs 68.1±3.1%, p>0.05; LVGLS –24.8±2.1% vs –25.3±2.3%, p>0.05; LALS 45.7±4.1% vs 46.5±4.4%, p>0.05). RVLS correlated with LAVi (r=0.53, p<0.01) and LALS (r=0.57, p<0.01). Regression analysis defined RVLS as an independent predictor of symptoms development (OR=3.2; 95% CI=1.37–7.63; p<0.01). Conclusion RV longitudinal strain predicts symptoms in patients with chronic primary mitral regurgitation.

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Right versus left heart reverse remodelling after treating ischaemic mitral and tricuspid regurgitation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa326 ◽

2020 ◽

Author(s):

Haytham Elgharably ◽

Hoda Javadikasgari ◽

Marijan Koprivanac ◽

Ashley M Lowry ◽

Kimi Sato ◽

...

Keyword(s):

Mitral Regurgitation ◽

Ejection Fraction ◽

Tricuspid Regurgitation ◽

Tricuspid Valve Repair ◽

Left Heart ◽

Valve Repair ◽

Right Heart ◽

Reverse Remodelling ◽

The Right

Abstract OBJECTIVES Repair outcomes of tricuspid regurgitation (TR) associated with ischaemic mitral regurgitation (IMR) are inferior to functional TR in terms of TR recurrence and right ventricular (RV) reverse remodelling. Our objective is to analyse right versus left heart reverse remodelling after surgery for IMR-associated TR. METHODS From 2001 to 2011, 568 patients with severe IMR underwent mitral valve surgery (repair 87%, replacement 13%), and 131 had concomitant tricuspid valve repair. Median follow-up was 3.0 years; 25% of living patients were followed up for 6.3 years. Longitudinal analysis of 1527 follow-up echocardiograms was performed to assess ventricular reverse remodelling and function. RESULTS Unlike the left heart, the right heart failed to reverse remodel (failed to recover ventricular function or halt dilatation). During follow-up after surgery, the right ventricle continued to dilate while the left ventricle regressed in size. RV ejection fraction decreased (46% at 1 month and 44% at 5 years), while left ventricular ejection fraction increased (33% and 37%, respectively). RV strain showed early (−11% at 1 month) and late (−12% at 5 years) dysfunction. Patients who underwent tricuspid valve repair had worse RV function. Mitral regurgitation remained stable after surgical intervention, and TR gradually recurred (37% moderate, 20% severe at 7 years). CONCLUSIONS Surgical treatment of IMR and TR along with revascularization failed to induce reverse remodelling of the right heart. These findings warrant further investigations to identify optimal timing and approach of intervention for IMR-associated TR with respect to RV remodelling.

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Clinical Outcomes of Mitral Annuloplasty with Flexible Bands in Ischemic Mitral Regurgitation

The Heart Surgery Forum ◽

10.1532/hsf.1994 ◽

2018 ◽

Vol 21 (5) ◽

pp. E345-E351 ◽

Cited By ~ 1

Author(s):

Mehmet Adnan Celkan ◽

Ismail Kork ◽

Abdullah Ulucay

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Odds Ratio ◽

Ischemic Mitral Regurgitation ◽

Redo Surgery ◽

Cox Regression Analysis ◽

Artery Disease

Background: In this study, we present the outcomes of 53 patients with concomitant coronary artery disease and ischemic mitral regurgitation (IMR)who underwent coronary bypass grafting (CABG) plus mitral repair (flexible posterior band annuloplasty). Materials and Methods: A total of 53 patients with concomitant ischemic mitral regurgitation and coronary artery disease underwent CABG plus posterior mitral band annuloplasty between June 2008 and June 2015. Flexible Duran AnCore® annuloplasty band (Medtronic) was used in all patients. Transesophageal echocardiography (TEE) was intraoperatively performed in all patients. A transthoracic (TTE) follow-up examination was performed at postoperative months 1, 3, 6, and 12. Results: The average cross-clamp and cardiopulmonary bypass times were 85.11 ± 5.79 and 105.98 ± 6.14 minutes, respectively. Postoperatively, there was an improvement in the grade of mitral regurgitation from 3.8 to 0.7 and in the NYHA class from 3.1 ± 0.5 to 0.5 ± 0.6 (both P < .001). In addition, statistically significant reductions in LVEDD, LVESD, and PAP were observed (P < .001). Ejection fraction rose from 39 ± 10% to 45 ± 8% (P < .01). Early mortality rate was 7.5% (n = 4). Mean follow-up was at 16 months. Late mortality occurred in one patient. During the follow-up period, reoperation was required in 2 patients. Only 2 parameters, redo surgery (P = .030) and IABP use (P = .021), were found related to mortality (P < .001). Cox regression analysis showed that redo surgery and postoperative bleeding increased mortality by 14.731 times (odds ratio: 14.731; 95% confidence interval [CI]: 1.530-141.852) and 23.839 times (odds ratio: 23.839; 95% CI: 1.478-348.641). Discussion: In patients with IMR, mitral band annuloplasty performed in conjunction with CABG was associated with an increase in functional capacity and ejection fraction as well as a reduction in LVEDD and LVESD. This approach represents a feasible alternative with low mortality and prevents future development of mitral regurgitation and the need for redo surgery.

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Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation

Circulation ◽

10.1161/circulationaha.104.524421 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Cited By ~ 2

Author(s):

Akira Matsunaga ◽

Carlos M. G. Duran

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

De Novo ◽

Ischemic Mitral Regurgitation ◽

Tricuspid Annulus ◽

Valve Repair ◽

Functional Tricuspid Regurgitation ◽

Cardiac Lesions

Background— Despite correction of left-sided cardiac lesions, associated functional tricuspid regurgitation (TR) that was surgically ignored can persist. It can also appear de novo. The aim of this study was to analyze TR in a group of patients who underwent successful revascularization and mitral valve repair (MVRep) for functional ischemic mitral regurgitation (MR). Methods and Results— Among 124 consecutive patients with MVRep, 70 left the operating room with MR ≤1+ and had a preoperative and follow-up transthoracic echocardiogra. Moderate or greater MR or TR was considered significant. Twenty-one patients (30%) had TR before surgery, and only 9 had TR repaired. The postoperative incidence of residual TR was not significantly different whether the tricuspid valve had been repaired (4 of 9 [44%]) or surgically ignored (8 of 12 [67%]). At last follow-up, 34 patients (49%) had significant TR. The incidence of TR increased from 25% at <1 year to 53% between 1 and 3 years and 74% at >3 years. Absence or presence of recurrent MR did not significantly affect TR (14 of 22 [64%] with MR versus 20 of 48 [42%] with no MR). Preoperative and postoperative tricuspid annulus size in patients with late TR was significantly larger than in patients without TR. Conclusions— Functional TR is frequently associated with functional ischemic MR. After MVRep, close to 50% of patients have TR. The incidence of postoperative TR increases with time. Preoperative tricuspid annulus dilation might be a predictor of late TR.

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CHANGES IN PULMONARY FUNCTION AND PULMONARY ARTERY PRESSURE IN COMBINED PULMONARY FIBROSIS AND EMPHYSEMA: FOLLOW-UP EXAMINATION

Respirology ◽

10.1111/resp.13207_159 ◽

2017 ◽

Vol 22 ◽

pp. 143-143

Keyword(s):

Pulmonary Fibrosis ◽

Pulmonary Artery ◽

Pulmonary Function ◽

Pulmonary Artery Pressure ◽

Artery Pressure

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Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.11.066 ◽

2021 ◽

Vol 77 (6) ◽

pp. 713-724 ◽

Cited By ~ 1

Author(s):

Philippe B. Bertrand ◽

Jessica R. Overbey ◽

Xin Zeng ◽

Robert A. Levine ◽

Gorav Ailawadi ◽

...

Keyword(s):

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

Ischemic Mitral Regurgitation

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Sex-differences in left ventricular remodeling and mechanics after aortic valve surgery in patients with severe aortic valve disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.1605 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

G K Singh ◽

E M Vollema ◽

E A Prihadi ◽

M V Regeer ◽

S H Ewe ◽

...

Keyword(s):

Sex Differences ◽

Aortic Valve ◽

Ejection Fraction ◽

Aortic Valve Disease ◽

Valve Disease ◽

Men And Women ◽

Lv Mass ◽

Lv Remodeling ◽

Lv Ejection Fraction

Abstract Background Sex-differences in left ventricular (LV) remodeling in patients with aortic valve disease have been reported. However, sex-differences in LV remodeling and mechanics in response to aortic valve replacement (AVR) remained largely unexplored. Purpose The present study aimed to evaluate the sex-differences during the time course of LV remodeling and LV mechanics (by LV global longitudinal strain (GLS)) after aortic valve replacement. Methods Patients with severe aortic valve disease (aortic stenosis (AS) or aortic regurgitation (AR)) undergoing AVR with echocardiographic follow-up at 1,2, and/or 5 years were evaluated. LV mass index, LV ejection fraction, LV GLS and stroke volume (SV) were measured. Linear mixed models analyses were used to assess changes in LV mass index, LVEF, LV GLS and SV between time points. The models were corrected for age, LV end-diastolic diameter at baseline and time between echocardiograms. Results A total of 211 patients (61±14 years, 61% male) with severe aortic valve disease (AS 63% or AR 39%) were included. Before AVR, men had larger LV mass index and higher SV compared to women. Both men and women had a preserved LV ejection fraction (54±12 and 56±9, P=0.102, respectively), but moderately impaired LV GLS (14.6±4.1 and 16.1±4.1, P=0.009, respectively). After AVR, both groups showed LV mass regression, improvement in LV ejection fraction and LV GLS. LV mass index and SV remained higher in men. During follow-up women showed significantly better LV GLS compared to men (P=0.030, figure 1). Conclusion In men and women with severe aortic valve disease undergoing AVR, the time course of changes in LV mass regression, LV ejection fraction, LV GLS and SV are similar. During follow-up LV mass index remained larger in men and women showed significantly better LV GLS. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The department of Cardiology received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, MSD and Medtronic. Nina Ajmone Marsan received speakers fees from Abbott Vascular and GE healthcare. Jeroen J Bax received speaker fees from Abbott Vascular. The remaining authors have nothing to disclose.

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