Ventricular Interaction in a Patient With Heart Failure With Preserved Ejection Fraction and Severe Tricuspid Regurgitation

2021 ◽  
Author(s):  
Karl-Patrik Kresoja ◽  
Karl-Philipp Rommel ◽  
Holger Thiele ◽  
Philipp Lurz
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Preserved Ejection Fraction ◽  
Severe Tricuspid Regurgitation ◽  
Ventricular Interaction

scholarly journals Internal Jugular Venous Pseudoaneurysm in a Patient with Heart Failure and Severe Tricuspid Regurgitation

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Sujoy Phookan ◽  
Patrick T. Strickland ◽  
Bishoy Hanna ◽  
Gregory R. Hartlage ◽  
Ankit Parikh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Neck Mass ◽  
Preserved Ejection Fraction ◽  
Lateral Neck ◽  
Severe Tricuspid Regurgitation

The differential diagnosis of a lateral neck mass includes a number of possible etiologies. While jugular venous aneurysms and pseudoaneurysms are rare entities, they should be considered in the differential diagnosis of a pulsatile lateral neck mass. We present a case of an idiopathic jugular venous pseudoaneurysm and its association with worsening tricuspid regurgitation in a patient with heart failure with preserved ejection fraction.

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

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.

scholarly journals Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper K. Jensen ◽  
Tor S. Clemmensen ◽  
Christian A. Frederiksen ◽  
Joachim Schofer ◽  
Mads J. Andersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Output ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Tricuspid Regurgitation ◽  
Clinical Performance ◽  
Chronic Atrial Fibrillation ◽  
Peak Exercise ◽  
Preserved Ejection Fraction

Abstract Objective The study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR). Background Symptoms and clinical performance of severe AF-FTR mimic the population of patients with heart failure with preserved ejection fraction (HFpEF). Severe AF-FTR is known to be associated with an adverse prognosis whereas less is reported about the clinical performance including exercise capacity and hemodynamics in patients symptomatic AF-FTR. Methods Right heart catheterization (RHC) at rest and during exercise was conducted in a group of patients with stable chronic AF-TR and compared with a group of patients with HFpEF diagnosed with cardiac amyloid cardiomyopathy (CA). All patients had preserved ejection fraction and no significant left-sided disease. Results Patients with AF-FTR demonstrated a low exercise capacity that was comparable to CA patients (TR 4.9 ± 1.2 METS vs. CA 4. 7 ± 1.5 METS; P = 0.78) with an average peak maximal oxygen consumption of 15 mL/min/kg. Right atrium pressure increased significantly more in the AF-FTR patients as compared to CA patients at peak exercise (25 ± 8 vs 19 ± 9, p < 0.01) whereas PCWP increased significantly to a similar extent in both groups (31 ± 4 vs 31 ± 8 mmHg, p = 0.88). Cardiac output (CO) was significantly lower among AF-FTR at rest as compared to CA patients (3.6 ± 0.9 vs 4.4 ± 1.3 l/min; p < 0.05) whereas both groups demonstrated a poor but comparable CO reserve at peak exercise (7.3 ± 2.9 vs 7.9 ± 3.8 l/min, p = 0.59). Conclusions AF-FTR contributes to the development of advanced heart failure symptoms and poor exercise capacity reflected in increased atrial filling pressures, reduced cardiac output at rest and during exercise sharing common features seen in HFpEF patients with other etiologies.

Clinical Performance and Exercise Hemodynamics in Patients with Severe Secondary Tricuspid Regurgitation and Chronic Atrial Fibrillation

2021 ◽  
Author(s):  
Jesper Jensen ◽  
Tor Clemmensen ◽  
Christian Frederiksen ◽  
Joachim Schofer ◽  
Mads Andersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Output ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Tricuspid Regurgitation ◽  
Clinical Performance ◽  
Chronic Atrial Fibrillation ◽  
Peak Exercise ◽  
Preserved Ejection Fraction

Abstract ObjectiveThe study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR).BackgroundSymptoms and clinical performance of severe AF-FTR mimic the population of patients with heart failure with preserved ejection fraction (HFpEF). Severe AF-FTR is known to be associated with an adverse prognosis whereas less is reported about the clinical performance including exercise capacity and hemodynamics in patients symptomatic AF-FTR. MethodsRight heart catheterization (RHC) at rest and during exercise was conducted in a group of patients with stable chronic AF-TR and compared with a group of patients with HFpEF diagnosed with cardiac amyloid cardiomyopathy (CA). All patients had preserved ejection fraction and no significant left-sided disease. ResultsPatients with AF-FTR demonstrated a low exercise capacity that was comparable to CA patients (TR 4.9 ± 1.2 METS vs. CA 4. 7 ± 1.5 METS; P = 0.78) with an average peak maximal oxygen consumption of 15 mL/min/kg. Right atrium pressure increased significantly more in the AF-FTR patients as compared to CA patients at peak exercise (25 ± 8 vs 19 ± 9, p<0.01) whereas PCWP increased significantly to a similar extent in both groups (31 ± 4 vs 31 ± 8 mmHg, p=0.88). Cardiac output (CO) was significantly lower among AF-FTR at rest as compared to CA patients (3.6 ± 0.9 vs 4.4 ± 1.3 l/min; p<0.05) whereas both groups demonstrated a poor but comparable CO reserve at peak exercise (7.3 ± 2.9 vs 7.9 ± 3.8 l/min, p=0.59). ConclusionsAF-FTR contributes to the development of advanced heart failure symptoms and poor exercise capacity reflected in increased atrial filling pressures, reduced cardiac output at rest and during exercise sharing common features seen in HFpEF patients with other etiologies.

scholarly journals Presence of ´isolated´ tricuspid regurgitation should prompt the suspicion of heart failure with preserved ejection fraction

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0171542 ◽  
Author(s):  
Julia Mascherbauer ◽  
Andreas A. Kammerlander ◽  
Caroline Zotter-Tufaro ◽  
Stefan Aschauer ◽  
Franz Duca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Preserved Ejection Fraction

Independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation severity in heart failure with preserved ejection fraction

2020 ◽  
Author(s):  
Tomonari Harada ◽  
Masaru Obokata ◽  
Kazunori Omote ◽  
Hiroyuki Iwano ◽  
Takahiro Ikoma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Prognostic Value ◽  
Current Data ◽  
Preserved Ejection Fraction ◽  
Vena Contracta ◽  
All Cause Mortality ◽  
Incremental Prognostic Value

Abstract Aims This study sought to determine the independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation (TR) severity over right heart remodelling and pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF). Methods and results Echocardiography was performed on 311 HFpEF patients. TR severity was defined by the semiquantitative measures [i.e. vena contracta width (VCW) and jet area] and by the guideline-based integrated qualitative approach (absent, mild, moderate, or severe). All-cause mortality or heart failure hospitalization occurred in 101 patients over a 2.1-year median follow-up. There was a continuous association between TR severity and the composite outcome with a hazard ratio (HR) of 1.17 per 1 mm increase of VCW [95% confidence interval (CI) 1.08–1.26, P &lt; 0.0001]. Compared with patients with the lowest VCW category (≤1 mm), RV-adjusted HRs for the outcome were 1.99 (95% CI 1.05–3.77), 2.63 (95% CI 1.16–5.95), and 5.00 (95% CI 1.60–15.7) for 1–3, 3–7, and ≥7 mm VCW categories, respectively. TR severity as defined by the guideline-based approach showed a similarly graded association, but it was no longer significant in models including PH. In contrast, VCW remained independently and incrementally associated with the outcome after adjusting for established prognostic factors, as well as RV diameter and PH (fully adjusted HR 1.14 per 1 mm, 95% CI 1.02–1.27, P = 0.02; χ2 58.8 vs. 51.5, P = 0.03). Conclusion The current data highlight the potential value of the semiquantitative measures of TR severity for the risk stratification in patients with HFpEF.

scholarly journals The prevalence and prognosis of tricuspid regurgitation in stage A to C heart failure with preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Q.W Ren ◽  
Y Chen ◽  
M.Z Wu ◽  
Y.J Yu ◽  
K.H Yiu
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Prognostic Value ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Heart Failure Hospitalization ◽  
Kaplan Meier ◽  
Severe Degree

Abstract Background Previous studies have demonstrated that the presence of moderate and severe degree of tricuspid regurgitation (TR) is associated with adverse outcome in patients with heart failure with reduced ejection fraction. However, little is known about the prevalence and prognostic value of TR in patients with stage A, B and C heart failure with preserved ejection fraction (HFpEF). Purpose The aims of this study is to investigate the prevalence and prognostic value of TR in patients with stage A, B and C HFpEF. Methods A total of 2882 patients with stage A (n=904), B (n=1305) and C (n=673) HFpEF from 2013 to 2017 were enrolled. Detailed transthoracic echocardiogram was performed and the severity of TR was graded according to the latest recommendation. Patients were prospectively followed up at our heart failure clinic. Results The average age of the study population was 65 and 47% were male. Hypertension was presence in 58% and diabetes in 33% and the mean left ventricular ejection fraction was 62%. The prevalence of moderate and severe TR increased from stage A to C heart failure (HF) (4.2%, 5.9% and 16.5%, respectively, P&lt;0.01). Kaplan-Meier curve revealed that the presence of moderate and severe degree of TR was associated with all-cause mortality and heart failure hospitalization (Log-rank test P&lt;0.01) (Figure). Multivariable analysis demonstrated that moderate (hazard ratio=1.57, P&lt;0.01) and severe TR (hazard ratio=2.53, P&lt;0.01) was associated with mortality and heart failure hospitalization after adjusting for age, gender, ejection fraction, atrial fibrillation and HF stage. Conclusions The presence of moderate and severe TR is not uncommon in patients with stage A, B and C HFpEF. Importantly, moderate and severe TR was independently associated with mortality and heart failure hospitalization. Kaplan-Meier curve for the impact of TR Funding Acknowledgement Type of funding source: None

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