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.

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.

scholarly journals 144 Atrial and ventricular phenotypes in a cohort of patients with functional tricuspid regurgitation: clinical, echocardiographic, and prognostic aspects

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Mara Gavazzoni ◽  
Francesca Heilbron ◽  
Denisa Florescu ◽  
Pellegrino Ciampi ◽  
Andrada C Guta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Composite Endpoint ◽  
Right Atrial ◽  
P Value ◽  
Functional Tricuspid Regurgitation ◽  
And Function ◽  
Rv Function

Abstract Aims Atrial functional tricuspid regurgitation (A-FTR) has emerged as a newly recognized phenotype of functional tricuspid regurgitation (FTR), occurring in patients with atrial fibrillation and right atrial (RA) dilation but normal right ventricular (RV) size and function. Its prevalence, echocardiographic features, and prognosis have not yet clarified since most evidence to date has included indiscriminately FTR patients with A-FTR and ventricular form (V-FTR). Aim of this study was to investigate the differences between these two phenotypes of FTR in terms of clinical correlates, echocardiographic aspects, and prognosis. Methods and results A total of 180 consecutive patients with moderate to severe FTR referred for echocardiography in two Italian centres were retrospectively enrolled. A-FTR was defined as: (1) longstanding atrial fibrillation; (2) PASP <50 mmHg; (3) left ventricular ejection fraction > 60% (complete according to the ACC guidelines); and (4) no significant left side valve disease. 3D TTE was used for the quantitative assessment of TR and chamber sizing and function. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis; secondary endpoint was HF-hospitalization. Patients with A-FTR were 30% of the population; they were older than those one with V-FTR; with higher systolic blood pressure and less advanced symptoms. Chronic obstructive pulmonary disease was more prevalent in V-FTR. Patients with V-FTR had larger 3D-derived right ventricle (RV) volumes, both diastolic and systolic, while right ventricle ejection fraction (RVEF) was similar. RV functional parameters as TAPSE, RVFWLS, and RVGLS were significantly lower in the V-FTR patients as well as all the parameters of RV-pulmonary arterial (PA) coupling. After a median follow-up of 24 months (IQR: 2–48), 72 patients (40%) reached the primary endpoint and 64 (36%) hospitalized for HF. The rate of composite endpoint tended to be lower in A-FTR than in V-FTR (29% vs. 44%, P-value: 0.1); the rate of hospitalization for HF was higher in V-FTR patients (22% vs. 41%, P-value: 0.04). Correlates of combined endpoint in both groups were: functional class of dyspnoea (NYHA class III–IV vs. I–II), severe TR grade (HR in V-FTR: 2.88 [1.63–5.06], P < 0.01; HR in A-FTR: 8[3–17], P < 0.01); RV volumes, RA volumes. Estimated SPAP as well as all the parameters of RV function and of RV-PA coupling were correlates of prognosis only in V-FTR; conversely, parameters of TA dimensions were related to combined Endpoint in A-FTR phenotype, while RV function and RV-PA coupling indexes did not. Conclusions Patients having A-FTR have an incidence of combined endpoint slightly different, without reaching a statistically significant difference, thus remarking the fact that A-FTR could not be considered ‘more benign’ and should therefore be targeted. Prognostic predictors are different between A-.FTR and V-FTR patients.

scholarly journals 43 Echocardiographical analysis of right ventricular function after transcatheter edge-to-edge repair of tricuspid regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Ozturk ◽  
J Vogelhuber ◽  
D Reckers ◽  
M U Becher ◽  
G Nickenig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Regurgitation ◽  
Systolic Function ◽  
Right Heart Failure ◽  
Tissue Doppler ◽  
High Grade ◽  
Myocardial Performance ◽  
Right Heart ◽  
Color Tissue Doppler ◽  
Rv Function

Abstract Tricuspid regurgitation (TR) is a frequent valvular heart disease associated with increased mortality and morbidity. RV function is mostly assessed using tricuspid annulus plane systolic excursion (TAPSE), which shows merely systolic RV function and can be influenced by many other pathologies and image quality. Furthermore, the impact of dedicated percutaneous clip treatment of TR on RV global function and clinical outcomes are scarce. We aim to perform detailed echocardiographical global RV function analysis inclusively speckle tracking of RV before and after transcatheter edge-to-edge repair of TR (TTVR). We evaluated 50 patients, who underwent between January 2017 to March 2018 TTVR in our center. Apical four chamber images were used to perform strain analysis of RV. The systolic velocity of free RV wall (S´ Vmax) was measured through PW doppler on lateral TV annulus in color tissue Doppler. RV myocardial performance index is a parameter for systolic as well as diastolic ventricle function and can be calculated using ratio between TV closure to opening time and RV ejection time (RVCOT-RVET/RVET), which can be assessed from PW Doppler of lateral TV annulus in color tissue Doppler. We retrospectively included 40 patients (73 ± 5.6 years, 32% female) with symptomatic (65% ascites, 95% edema, 100% NYHA > II) high grade functional TR at surgical high risk (EuroSCORE II: 7.6%). 95% of all interventions were successfully performed (TR reduction at least I grade). Our collective shows normal baseline left ventricle (LV) systolic function (Ejection fraction: 60.8 ± 4.6%) with diastolic LV dysfunction and increased LV end systolic pressure (E/E´ ratio: 17.7 ± 6.5). Baseline RV analysis presented impaired RV systolic function (TAPSE: 1.2 ± 3.2 cm, RV-FAC: 25.6 ± 9.8%, S´ Vmax: 5.6 ± 1.2cm/s) with decreased RV global longitudinal strain (RV-GLS: -8.9 ± 4.3). RV myocardial performance index (RV-MPI) was 0.51 ± 0.4 as a parameter for poor global RV function. Baseline echocardiography showed dilation of both atria (Left atrium: 80.5 ± 14.5ml, right atrium: 26.7 ± 7.8cm2) with pronounced right ventricle congestion (dilated vena cava inferior: 25.5 ± 3.4mm without breath modulation, paradoxical intraventricular septum motion, dilated RV: 57.7 ± 14.5cm2). All TR were high grade (PISA: 0.78 ± 0.3cm, VC width: 0.8 ± 0.2cm, EROA: 0.43 ± 0.1cm2, regurgitant volume: 67.1 ± 10.4ml) and functional with mostly anteroseptal (85%) coaptation defect (coaptation defect diameter: .5.7 ± 3.2mm). The right heart failure symptoms significantly improved three months after the procedure. Patients with severe right heart failure (TAPSE < 1cm) showed more often rehospitalization and limited improvements in symptoms (p = 0.02). RV function should be more comprehensively evaluated before interventional TR therapy. The patients with already preprocedural severe right heart failure should be more critically discussed. RV-GLS and RV-MPI are strongest independent parameter of clinical outcome after TTVR.

scholarly journals Results after Repair of Functional Tricuspid Regurgitation with a Three-Dimensional Annuloplasty Ring

2021 ◽  
Vol 10 (21) ◽  
pp. 5080
Author(s):  
Elda Dzilic ◽  
Thomas Guenther ◽  
Amel Bouziani ◽  
Bernhard Voss ◽  
Stephanie Voss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Recommended Treatment ◽  
Functional Tricuspid Regurgitation ◽  
Cardiac Procedure ◽  
Wide Range ◽  
Reoperation Rates

Background: Tricuspid valve (TV) repair is the recommended treatment for severe functional tricuspid regurgitation (fTR) in patients undergoing left-sided surgery. For this purpose, a wide range of annuloplasty devices differing in form and flexibility are available. This study reports the results using a three-dimensional annuloplasty ring (Medtronic, Contour 3D Ring) for TV repair and analysis of risk factors. Methods: A cohort of 468 patients who underwent TV repair (TVr) with a concomitant cardiac procedure from December 2010 to January 2017 was retrospectively analyzed. Results: At follow-up, 96.1% of patients had no/trivial or mild TR. The 30-day mortality was 4.7%; it significantly differed between electively performed operations (2.7%) and urgent/emergent operations (11.7%). Risk factors for recurrent moderate and severe TR were LVEF < 50%, TAPSE < 16 mm, and moderate mitral valve (MV) regurgitation at follow-up. Preoperatively reduced renal function lead to a higher 30-day and overall mortality. Reoperation of the TV was required in six patients (1.6%). Risk factors for TV related reoperations were preoperative TV annulus over 50 mm and an implanted permanent pacemaker. Conclusions: TVr with the Contour 3D annuloplasty ring shows low TR recurrence and reoperation rates. Risk-factor analysis for the recurrence of TR revealed the importance of left- and right-ventricular function.

Early Experiences With a New Three-Dimensional Annuloplasty Ring for the Treatment of Functional Tricuspid Regurgitation

2014 ◽  
Vol 98 (6) ◽  
pp. 2039-2044 ◽  
Author(s):  
Thomas Ratschiller ◽  
Thomas Guenther ◽  
Ralf Guenzinger ◽  
Christian Noebauer ◽  
Victoria Kehl ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Functional Tricuspid Regurgitation ◽  
Early Experiences

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.

P4356Assessment of global and regional right ventricular systolic function in restrictive pulmonary disease by novel speckle tracking 3D echocardiography comparison with cardiac magnetic resonance imaging

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tanwar ◽  
N Sen ◽  
A Jain ◽  
A Mehta ◽  
B Kalra ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Systolic Function ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
End Diastolic Volume ◽  
Echocardiographic Parameters ◽  
Rv Function ◽  
Area Strain

Abstract Background Chronic restrictive pulmonary disease may alter right and left ventricular function by changing intrathoracic pressure. Pulmonary hyperinflation may increase right atrial pressure, leading to reduced venous return and subsequent reductions in RV pre-load. In CRPD patients, hyperinflation has been directly correlated with reduced atrial chamber size, global RV dysfunction, and reduced LV filling. Accurate assessment of global and regional right ventricular (RV) systolic function is challenging. Purpose The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function. Methods In a retrospective, cross-sectional study setting, RV volumetric data were studied in 200 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments. Results 136 patients (68%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R2=0.89; RV end-systolic volume, R2=0.82; RV ejection fraction [RVEF], R2=0.68; P<0.003 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, −3% and −8 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r=0.30, P=0.005). Among segmental 3D strain variables, inlet area strain (r=−0.49, P<0.004) and outflow circumferential strain (r=−0.39, P<0.005) were independent factors associated with CMR-derived RVEF. Conclusions Severity of restrictive pulmonary disease influences RV systolic dysfunction, which is reflected in speckle tracking 3D echocardiographic parameters. Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain.RV volume and RVEF determined by STE were comparable with CMR measurements.

scholarly journals Six-month Performance of a Three-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

2018 ◽  
Vol 66 (S 01) ◽  
pp. S1-S110
Author(s):  
R. Guenzinger ◽  
R. Lange ◽  
F. Rieß ◽  
T. Hanke ◽  
N. Bischoff ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Functional Tricuspid Regurgitation
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