P6488Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure Results A total of 70 patients were included (mean age was 74±8 years, 71% females). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes. Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001 Conclusion In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.

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P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance

European Heart Journal ◽

10.1093/eurheartj/ehz746.0510 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Hinojar Baydes ◽

A Garcia Martin ◽

A Gonzalez-Gomez ◽

G Alonso-Salinas ◽

M Plaza-Martin ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valve Surgery ◽

Regurgitant Fraction ◽

End Point ◽

Tricuspid Valve Surgery ◽

Poor Outcomes

Abstract Background Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown. Purpose Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all). Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01 Conclusion Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.

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The utility of transthoracic echocardiographic measures of right ventricular systolic function in a lung resection cohort

Echo Research and Practice ◽

10.1530/erp-18-0067 ◽

2019 ◽

Vol 6 (1) ◽

pp. 7-15 ◽

Cited By ~ 3

Author(s):

Philip McCall ◽

Alvin Soosay ◽

John Kinsella ◽

Piotr Sonecki ◽

Ben Shelley

Keyword(s):

Right Ventricular ◽

Longitudinal Strain ◽

Systolic Function ◽

Characteristic Curve ◽

Lung Resection ◽

Reference Method ◽

Predictive Ability ◽

S Wave ◽

Operative Assessment ◽

Rv Function

Right ventricular (RV) dysfunction occurs following lung resection and is associated with post-operative complications and long-term functional morbidity. Accurate peri-operative assessment of RV function would have utility in this population. The difficulties of transthoracic echocardiographic (TTE) assessment of RV function may be compounded following lung resection surgery, and no parameters have been validated in this patient group. This study compares conventional TTE methods for assessing RV systolic function to a reference method in a lung resection population. Right ventricular index of myocardial performance (RIMP), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and S′ wave velocity at the tricuspid annulus (S′), along with speckle tracked global and free wall longitudinal strain (RV-GPLS and RV-FWPLS respectively) are compared with RV ejection fraction obtained by cardiovascular magnetic resonance (RVEFCMR). Twenty-seven patients undergoing lung resection underwent contemporaneous CMR and TTE imaging; pre-operatively, on post-operative day two and at 2 months. Ability of each of the parameters to predict RV dysfunction (RVEFCMR<45%) was assessed using the area under the receiver operating characteristic curve (AUROCC). RIMP, FAC and S′ demonstrated no predictive value for poor RV function (AUROCC <0.61,P > 0.05). TAPSE performed marginally better with an AUROCC of 0.65 (P = 0.04). RV-GPLS and RV-FWPLS demonstrated good predictive ability with AUROCC’s of 0.74 and 0.76 respectively (P < 0.01 for both). This study demonstrates that the conventional TTE parameters of RV systolic function are inadequate following lung resection. Longitudinal strain performs better and offers some ability to determine poor RV function in this challenging population.

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P288 Prognostic role of hemoglobin levels in patients with severe tricuspid regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.142 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Garcia Martin ◽

R Hinojar ◽

A Gonzalez Gomez ◽

M Plaza Martin ◽

M Pascual Izco ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valve Surgery ◽

Therapeutic Options ◽

Severe Tricuspid Regurgitation ◽

End Point ◽

Tricuspid Valve Surgery

Abstract Background Patients with severe tricuspid regurgitation (TR) frequently develop heart failure (HF) and their surgical therapeutic options are limited because of very high or prohibitive risk. According to the 2016 ESC guidelines for HF, anaemia and iron deficiency are associated with worse prognosis and intravenous iron therapy should be considered in symptomatic patients with HF reduced ejection fraction (HFrEF) in order to alleviate symptoms, improve exercise capacity and quality of life. The effect of treating iron deficiency in HF preserved ejection fraction (HFpEF) is unknown. The purpose of this study was to analyze the correlation between levels of hemoglobin (Hb) and the prognosis in patients with severe TR and preserve EF. Methods Consecutive patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015-2018 were included. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 70 patients were included (mean age was 74± 8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean left ventricular ejection fraction was 56,5% ±6,7%. During a median follow up of 18 months [IQR: 4-28], 35% of the patients reached the combined end-point (n = 16 developed right HF, n = 17 underwent tricuspid valve surgery, and n = 3 died). Patients with events showed lower Hb values (p = 0.04). The level of anaemia was a prognostic factor of the combined endpoint (per gr/dl, HR 0.77 [0-61-0.98], p = 0.036). Conclusion Hemoglobin is predictive of poor outcomes in patients with significant TR. According to these preliminary results, iron deficiency could be a therapeutic target in this subgroup of patients with limited therapeutic options.

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P5569Effective regurgitant oriffice area vs vena contracta method as predictors of outcomes in severe tricuspid regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehz746.0513 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Garcia Martin ◽

R Hinojar ◽

A Gonzalez Gomez ◽

M Pascual Izco ◽

M Plaza Martin ◽

...

Keyword(s):

Heart Failure ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Prognostic Value ◽

Valve Surgery ◽

Vena Contracta ◽

End Point ◽

Asymptomatic Patients ◽

Tricuspid Valve Surgery

Abstract Background There is no gold standard echocardiographic method to evaluate tricuspid regurgitation (TR) severity. ESC guidelines recommend using a combination of several methods. The purpose of this study was to compare the prognostic value of the two most commonly used methods for the evaluation of the TR: Effective regurgitant orifice area (EROA) method and biplane vena contracta (VC) method. Methods Consecutive asymptomatic patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015–2018 were included. TR severity was evaluated by a combination of several methods, including EROA method and biplane VC method, using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 70 patients were included (mean age was 74±8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). During a median follow up of 18 months [IQR: 4–28], 35% of the patients reached the combined end-point (n=16 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed a larger EROA (0.55 vs 0.40 p: 0.036) but no significance different was found in VC (8.03 vs 7.80 p: 0.27). Among both parameters, the tricuspid EROA was the only prognostic factor of the combined endpoint (EROA, HR 24.22 [1.54–380.86], p=0.023; VC, HR 1.022 [0.882–1.183]. A value of EROA of 0.42 reached the best accuracy to predicted poor outcomes (p<0.01). Conclusion Among the two most commonly used methods for the evaluation of the TR, EROA was the only method that obtained prognostic value during follow-up.

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Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa350 ◽

2020 ◽

Author(s):

Siddharth Pahwa ◽

Nishant Saran ◽

Alberto Pochettino ◽

Hartzell Schaff ◽

John Stulak ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congestive Heart Failure ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valve Surgery ◽

Late Mortality ◽

Functional Tricuspid Regurgitation ◽

Tricuspid Valve Surgery ◽

Independent Risk Factors

Abstract OBJECTIVES Functional tricuspid regurgitation (fTR) has been amenable to tricuspid valve repair (TVr), with fewer patients needing tricuspid valve replacement (TVR). We sought to review our experience of tricuspid valve surgery for fTR. METHODS A retrospective analysis of adult patients (≥18 years) who underwent primary tricuspid valve surgery for fTR (n = 926; mean age 68.6 ± 12.5 years; 67% females) from January 1993 through June 2018 was conducted. There were 767 (83%) patients who underwent TVr (ring annuloplasty, 67%; purse-string annuloplasty, 33%) and 159 (17%) underwent TVR (bioprosthetic valves, 87%; mechanical valves, 13%). The median follow-up was 8.2 years [95% confidence interval (CI) 7.2–8.9 years]. RESULTS A greater proportion of patients who underwent TVR had severe right ventricular dysfunction (P < 0.001), severe tricuspid regurgitation (P < 0.001) and congestive heart failure (P = 0.001) while the TVr cohort had a greater proportion with severe mitral valve (MV) regurgitation (P < 0.001) and concomitant cardiac procedures. Early mortality (TVR, 9% vs TVr, 3%; P = 0.004), renal failure (TVR, 10% vs TVr, 5%; P = 0.014) and hospital stay (TVR, 15 ± 15 days vs TVr, 12 ± 11 days; P < 0.001) were greater in TVR patients. The TVR cohort had worse survival [hazard ratio (HR) 1.57; 95% CI 1.23–1.99]. Multivariable analysis identified congestive heart failure (HR 1.37; 95% CI 1.10–1.72), renal failure (HR 1.79; 95% CI 1.14–2.82), previous MV surgery (HR 1.35; 95% CI 1.05–1.72) and TVR (HR 1.36; 95% CI 1.03–1.79) as independent risk factors for late mortality. CONCLUSIONS Tricuspid repair for fTR appears to have better early and late outcomes. Since previous MV surgery and TVR are identified as independent risk factors for late mortality, concomitant TVr at the time of index MV surgery may be considered. Early referral before the onset of advanced heart failure may improve outcomes.

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Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0117 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Hinojar Baydes ◽

A Gonzalez-Gomez ◽

A Garcia-Martin ◽

J M Monteagudo ◽

E A Rajjoub Al-Mahdi ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Prognostic Value ◽

Systolic Function ◽

Clinical Status ◽

Medical Systems ◽

S Wave ◽

Mean Values ◽

2D Echocardiography ◽

Rv Function

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (S') and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to right heart failure or cardiovascular mortality was defined. Results A total of 130 patients were included (mean age was 75±17 years, 69% females, 93% in NYHA I/II). According to etiology, 14% were primary TR and 86% were functional (49% due to corrected left valve disease and 37% due to tricuspid annulus dilatation). Mean values of RV function parameters are shown in the table. During a mean follow up of 18±8 months, n=39 patients (30%) reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p>0.05 for all). Conclusion In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients. FUNDunding Acknowledgement Type of funding sources: None. RV parameters

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Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1912 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Hinojar Baydes ◽

V De Angelis ◽

A Garcia-Martin ◽

A Gonzalez-Gomez ◽

M Sanroman ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Prognostic Value ◽

Systolic Function ◽

Clinical Status ◽

S Wave ◽

Mean Values ◽

2D Echocardiography ◽

Echocardiographic Parameters ◽

Rv Function

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave ('S) and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. A combined endpoint of hospital admission due to heart failure or cardiovascular mortality was defined. Results A total of 100 patients were included (mean age was 76±10 years, 65% females, 84% in NYHA I/II, 86% functional TR). Mean values of RV function parameters are shown in the table. During a mean follow up of 24±10 months, 24% of the patients reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS (p<0.01). Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p>0.05 for all). Conclusion In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients. Funding Acknowledgement Type of funding source: None

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Right ventricular systolic function in severe tricuspid regurgitation: prognostic relevance of longitudinal strain

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab030 ◽

2021 ◽

Author(s):

Francesco Ancona ◽

Francesco Melillo ◽

Francesco Calvo ◽

Nadia Attalla El Halabieh ◽

Stefano Stella ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Clinical Signs ◽

Strain Analysis ◽

Severe Tricuspid Regurgitation

Abstract Aims The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42–56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.

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