P1783Prognostic implications of significant tricuspid regurgitation in patients with atrial fibrillation in the absence of left-sided heart disease or pulmonary hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M F Dietz ◽  
E A Prihadi ◽  
P Van Der Bijl ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Event Free Survival ◽  
Free Survival ◽  
Rv Function

Abstract Background Tricuspid regurgitation (TR) can be caused by atrial fibrillation (AF) in the absence of left-sided heart disease or pulmonary hypertension. The prognostic impact of AF-TR has not been investigated. Purpose The aim of this study was to investigate the prognostic significance of TR in AF patients who do not show left-sided heart disease, pulmonary hypertension or primary structural abnormalities. Methods A total of 63 AF patients with moderate and severe TR were identified and matched by age and gender to 116 patients with AF without significant TR, resulting in a total study population of 179 patients (mean age 71±7 years, 59% male). As per design of the study, patients with primary TR, significant (moderate or severe) aortic and/or mitral valve disease, previous valvular surgery, congenital heart disease, left ventricular ejection fraction <50%, systolic pulmonary artery pressure >40mmHg, pacemaker or implantable cardioverter defibrillator leads in situ were excluded as well as patients with AF de novo. Patients were followed for the combined endpoint of all-cause mortality, hospitalization for heart failure and stroke. Results Patients with AF-TR had more often paroxysmal AF as compared to patients without TR (60% vs. 43%, p=0.028). In addition, right atrial volumes and the tricuspid annulus diameter (TAD) were significantly larger in patients with AF-TR compared to their counterparts (p<0.001 for all). Furthermore, tricuspid annular plane systolic excursion was significantly lower in patients with AF-TR (17±5 mm vs. 21±6 mm, p<0.001). During follow-up (median 62 [32–95] months) 55 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with TR were 71% and 53%, compared to 92% and 85% for patients without TR, respectively (Log rank Chi-Square p<0.001; Figure). In the multivariable Cox proportional hazard model adjusted for age, gender, NYHA functional class >2, renal function, right ventricular (RV) function and TAD, the presence of significant TR was independently associated with the combined endpoint (HR, 2.495; 95% CI, 1.167–5.335; p=0.018), while RV function was not (HR, 1.026; 95% CI, 0.971–1.085; p=0.364). Figure 1. Kaplan-Meier curves Conclusion In the absence of left-sided heart disease and pulmonary hypertension, significant TR is independently associated with worse event-free survival in patients with AF.

scholarly journals Different effects on right ventricular function in different etiology of secondary tricuspid regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
WC Tsai ◽  
WY Lee ◽  
MS Huang ◽  
WH Lee
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Right Atrial ◽  
Left Heart ◽  
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, Excutive Yuan, Taiwan Background Tricuspid regurgitation (TR) is traditionally classified as primary or secondary TR. The effects of TR on right ventricular (RV) function were not consistent. We hypothesized that secondary TR is not a unique group, sophisticated sub-grouping can be useful for studying effects of TR on RV function. Methods 207 consecutive patients identified as significant TR (moderate and severe) by echocardiography were recruited. Standard measurements for right heart were done according to guideline. Lateral tricuspid annulus systolic tissue velocity (S’) and RV fractional area change (FAC) were used for RV function. We classified these patients into primary TR and 6 subgroups of secondary TR according to a new systemic approach. Results Mean age of subjects was 71.2 ± 14.7 years, and there were 84 (40.6%) male. There were 29 (14%) primary TR. Secondary TR was further classified into 6 groups included 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13.0%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Among 4 major groups (congenital heart disease and RV myopathy were not included in analysis due to low numbers) of secondary TR, S’ was significant higher in idiopathic TR and RV FAC were higher in pacemaker related and idiopathic TR. RV dysfunction was defined as FAC &lt; 35%. RV dysfunction presented mostly in pulmonary hypertension related TR and leastly in idiopathic TR (59.3% vs. 14%, p &lt;0.001). Multivariate analysis using idiopathic TR as reference and controlled TR maximal velocity, RV end-diastolic area, right atrial area, and severity of TR, left heart disease related TR had higher risk of RV dysfunction (OR 4.178, 95% CI 1.490-11.703, p = 0.007). Conclusions Effects of TR on RV function were different among different subgroups of secondary TR. Left heart disease related TR had highest risk for RV dysfunction. Secondary TR should not be regarded as a single disease.

scholarly journals Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001104 ◽  
Author(s):  
Sahrai Saeed ◽  
Jenna Smith ◽  
Karine Grigoryan ◽  
Stig Urheim ◽  
John B Chambers ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
The Impact

ObjectivesThe true prevalence and disease burden of moderate or severe (significant) tricuspid regurgitation (TR) in patients undergoing routine echocardiography remains unknown. Our aim was to explore the prevalence of significant TR and the impact of pulmonary hypertension (PH) on outcome in a less selected cohort of patients referred to echocardiography.MethodsFrom 12 791 echocardiograms performed between January and December 2010, a total of 209 (1.6%) patients (72±14 years, 56% men) were identified with significant TR; 123 (0.96%) with moderate and 86 (0.67%) with severe TR. Median follow-up time was 80 months (mean 70±33 months). Systolic pulmonary artery pressure was derived from peak velocity of tricuspid regurgitant jet plus the right atrial pressure and considered elevated if ≥40 mm Hg (PH).ResultsDuring follow-up there were 123 (59%) deaths with no difference in mortality between moderate and severe TR (p=0.456). The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p<0.001). PH was associated with lower event-free survival in moderate (log-rank, p<0.001), but not in severe TR (log-rank, p=0.133). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S′, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95% CI 1.41 to 3.47, p=0.001).ConclusionsModerate or severe TR was found in 1.6% of patients attending for routine echocardiograms. PH identified a high-risk subset of patients with moderate TR but not with severe TR.

Abstract 16154: Baseline Left Ventricular Diameter Predicts Recovery in New Systolic Heart Failure Syndromes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel Gold ◽  
Nathan Kong ◽  
Matthew Gold ◽  
Tess Allan ◽  
Anand Shah ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Medical Decision ◽  
Left Ventricular Ejection ◽  
Internal Diameter ◽  
Event Free Survival ◽  
Short Term Treatment ◽  
Ventricular Ejection Fraction ◽  
Free Survival ◽  
Advanced Therapies

Introduction: It is unknown how often patients with very advanced left ventricular (LV) dilation at initial presentation demonstrate meaningful recovery with medical therapy. Understanding short term treatment outcomes may impact medical decision making and counseling. Hypothesis: Patients with left ventricular end diastolic internal diameter (LVEDD) > 6.5cm will be less likely to recover left ventricular ejection fraction (LVEF) as compared to patients with LVEDD < 6.5cm. Methods: Patients were retrospectively identified by a database search of echocardiogram studies obtained at the University of Chicago between 2008-2018. Manual review was performed to ensure new diagnosis of systolic dysfunction with LVEF ≤ 35% and follow up echocardiogram study within 3 to 9 months of index study. LVEDD was determined from parasternal long axis views per routine. LVEF recovery was specified as LVEF > 35%. Chart review was done to assess for composite death, hospice, transplant, left ventricular assist device, and sustained ventricular tachycardia. Chi-square, multivariable logistic regression, and Kaplan-Meier survival were used for analysis. Results: Out of 100 patients included for analysis, mean age was 59.7 years, 41 were female and 82 were African American. 17.7% of patients’ with LVEDD > 6.5 cm had LVEF recovery compared to 53.0% of patients’ with LVEDD ≤ 6.5 cm (p = 0.008). LVEDD > 6.5 cm was associated with less LVEF recovery even when adjusted for age, gender, hypertension, and diabetes (adjusted odds ratio 0.18, 95% CI 0.04 to 0.65). LVEDD > 6.5cm was associated with worse event free survival (p = 0.004) with a median follow-up time of 2.4 years. Conclusions: An LVEDD of > 6.5cm is associated with diminished LVEF recovery and event free survival when compared to those patients with an LVEDD ≤ 6.5cm. Delaying consideration for advanced therapies and device based therapies in hopes of recovery may be inappropriate for many such patients.

scholarly journals Incidence of Ventricular Arrhythmias and 1‐Year Predictors of Mortality in Patients Treated With Implantable Cardioverter‐Defibrillator Undergoing Generator Replacement

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Andrea Demarchi ◽  
Stefano Cornara ◽  
Antonio Sanzo ◽  
Simone Savastano ◽  
Barbara Petracci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ventricular Arrhythmias ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Generator Replacement

Background When implantable cardioverter defibrillator (ICD) battery is depleted most patients undergo generator replacement (GR) even in the absence of persistent ICD indication. The aim of this study was to assess the incidence of ventricular arrhythmias and the overall prognosis of patients with and without persistent ICD indication undergoing GR. Predictors of 1‐year mortality were also analyzed. Methods and Results Patients with structural heart disease implanted with primary prevention ICD undergoing GR were included. Patients were stratified based on the presence/absence of persistent ICD indication (left ventricular ejection fraction ≤35% at the time of GR and/or history of appropriate ICD therapies during the first generator's life). The study included 371 patients (82% male, 40% with ischemic heart disease). One third of patients (n=121) no longer met ICD indication at the time of GR. During a median follow‐up of 34 months after GR patients without persistent ICD indication showed a significantly lower incidence of appropriate ICD shocks (1.9% versus 16.2%, P <0.001) and ICD therapies. 1‐year mortality was also significantly lower in patients without persistent ICD indication (1% versus 8.3%, P =0.009). At multivariable analysis permanent atrial fibrillation, chronic advanced renal impairment, age >80, and persistent ICD indication were found to be significant predictors of 1‐year mortality. Conclusions Patients without persistent ICD indication at the time of GR show a low incidence of appropriate ICD therapies after GR. Persistent ICD indication, atrial fibrillation, advanced chronic renal disease, and age >80 are significant predictors of 1‐year mortality. Our findings enlighten the need of performing a comprehensive clinical reevaluation of ICD patients at the time of GR.

Abstract 2266: Development of Tricuspid Regurgitation Late After Left-Sided Valve Surgery in Patients without Significant Preoperative Tricuspid Regurgitation :A Single-Center Experience with Long-term Echocardiographic Examinations

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jae-Jin Kwak ◽  
Min-Kyung Kim ◽  
Hyung-Kwan Kim ◽  
Jin-Shik Park ◽  
Kyung-Hwan Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Tricuspid Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Right Atrial ◽  
Systolic Pulmonary Artery Pressure ◽  
Free Survival ◽  
Single Center Experience

Aim: We investigated the incidence and predictors of tricuspid regurgitation (TR) development long after left-sided valve surgery in patients without significant preoperative TR. Methods: Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without preoperative TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years. Results: Significant late TR was found in 90 patients (26.9%). Patients with late TR showed; an advanced age, a higher prevalence of atrial fibrillation and prior valve surgery, and a greater left atrial dimension. In addition, late TR was more frequent in patients with mitral valve surgery. Systolic pulmonary artery pressure and mean right atrial pressure were not different between the groups. Multivariate analysis showed that the preoperative atrial fibrillation (OR 5.37; 95% CI. 2.71–10.65; p<0.001) was the only independent factor of late TR development. Patients that developed late TR had a lower event-free survival rate than those that did not (p=0.03). Conclusion: The development of significant TR long after left-sided valve surgery is not uncommon and is associated with a poor prognosis. The preoperative atrial fibrillation is an independent predictor of the late TR. Main Clinical and Echocardiographic Characteristics According to the Presence of Significant Late TR

P1259Right atrial low voltage zone as a novel predictor of sinus node dysfunction in patients with non-paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kondo ◽  
M Kimura ◽  
M Nakayama ◽  
O Matsuda
Keyword(s):  
Atrial Fibrillation ◽  
Low Voltage ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Sinus Node Dysfunction ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Ablation Procedure ◽  
Ventricular Ejection Fraction

Abstract Background Although sinus node dysfunction (SND) coexists with atrial fibrillation (AF) in some cases, SND in patients with Non-paroxysmal AF (Non-PAF) could not be estimated in conventional electrophysiological study. Atrial low voltage zone (LVZ), which may be surrogate for atrial fibrosis, is although reported to present in patients with Non-PAF, the association between SND and right atrial LVZ (RA-LVZ) has not been fully evaluated. The aim of the present study was to assess the relationship between SND and RA-LVZ in patients with Non-PAF. Method Eighty-six Non-PAF patients underwent high density voltage mapping of right atrium (RA) during AF before ablation procedure. We defined LVZ as that with electrogram amplitude <0.1 mV in order to delineate strongly damaged area in RA. We evaluated the surface are of the RA-LVZ in Non-PAF patients with and without SND. Results Twenty-seven of 86 patients (31.4%) presented with SND after AF termination. There were no significant differences between patients with and without SND in variables such as age, sex, AF duration, left atrial diameter, and left ventricular ejection fraction. The mean value of RA-LVZ of all the patients was 12.1±11.4%, and RA-LVZ was significantly larger in patients with SND than in those without SND (22.8±14.6 vs 7.2±4.2%; P<0.001). In multivariate logistic regression analysis for the incidence of subsequent pacemaker implantation (PMI), only RA-LVZ was a significant predictor of subsequent PMI (odd ratio 1.306; 95% confidence interval 1.159 - 1.473; P<0.001). Receiving-operating characteristic curve for PMI following ablation procedure indicated cut-off value 10.5% for RA-LVZ with 85.2% sensitivity and 88.1% specificity (area under curve = 0.924, P<0.001). Kaplan-Meier analysis of the incidence of PMI after AF termination showed that freedom from pacemaker implantation was significantly better in patients with RA-LVA <10.5% than in those with RA-LVZ ≥10.5% (log-rank test; P<0.001). Conclusions Broad RA-LVZ measured during AF was strongly associated with SND and PMI after AF termination in patients with Non-PAF. Evaluation of RA-LVZ during AF could be a potential target in predicting SND requiring PMI in patients with Non-PAF.

scholarly journals Causal Relation of Tricuspid Regurgitation for Heart Failure Outcomes: A Mediation Analysis of Echocardiographic Predictors

2021 ◽  
Author(s):  
Daihiko Hakuno ◽  
Tomoaki Fukae ◽  
Masashi Takahashi ◽  
Koichiro Sueyoshi
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Mediation Analysis ◽  
Causal Relation ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Causal Mediation ◽  
Causal Mediation Analysis

Abstract Aims Although significant tricuspid regurgitation (TR) is critically associated with heart failure (HF) prognosis, the predictors for large TR impact on HF outcomes remain unknown. This study aimed to identify echocardiographic predictors for a causal relation of TR to HF outcomes. Methods and Results In a retrospective, acute HF cohort of 462 patients, multivariate logistic regression analysis was performed to determine subgroups with strong association of greater-than-moderate TR with HF readmission or cardiovascular death in a year. We then conducted causal mediation analysis according to persistent atrial fibrillation (Af) or mitral regurgitation to identify the echocardiographic predictors. The association of TR with HF outcomes was prominent in subgroups of females, with Af, the enlarged indexed tricuspid annular diameter (TADi) or right atrial area, or within certain ranges of the left ventricular ejection fraction, indexed right ventricular end-systolic area, or fractional area change (FAC). Causal mediation analysis found that the TR impact was significant in patients with Af. Furthermore, combination of TADi ≥ 2.1 cm/m2 and FAC ≥ 30%, which accounted for half of TR patients, predicted a much larger TR impact irrespective of Af and mitral regurgitation. Its prediction ability was superior to that of the modified Model for End-stage Liver Disease score. Conclusion The causal impact and burden of TR on HF outcomes was significant in patients with Af, and combining TADi ≥ 2.1 cm/m2 with FAC ≥ 30% could provide superior echocardiographic prediction of larger TR impact in HF 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 &lt;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 &lt;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 &lt;0.001) were best in idiopathic TR. RV dysfunction (FAC &lt; 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.

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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