Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure

Aim: This study evaluated how the presence of right-sided heart disease (RSHD), other valve disease (OVD) and heart failure (HF) impacts healthcare utilization in patients with tricuspid valve disease (tricuspid regurgitation [TR]). Materials & methods: Of the 33,686 patients with TR: 6618 (19.6%) had TR-only; 8952 (26.6%) had TR with HF; 12,367 (36.7%) had TR with OVD but no HF; and 5749 (17.1%) had TR with RSHD only. Results: The presence of RSHD, OVD or HF in patients with TR was independently associated with increased annualized hospitalizations, hospital days and costs relative to patients with TR alone. Conclusion: All three co-morbidities were associated with increased healthcare utilization, with HF showing the greatest impact across all measures.

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Valvular heart disease in autoimmune diseases in Mexico

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.071 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J Aceituno Melgar ◽

JF Fritche-Salazar ◽

ME Soto-Lopez

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Aortic Valve ◽

Aortic Stenosis ◽

Autoimmune Diseases ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valvular Heart Disease ◽

Valve Disease ◽

Calcium Deposit

Abstract Funding Acknowledgements Type of funding sources: None. Background The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart. Purpose Our objective was to describe the valvular heart disease (VHD) in patients with AD. Methods Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated. Results A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%). Conclusions We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients. Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.

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Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

Heart Vessels and Transplantation ◽

10.24969/hvt.2017.9 ◽

2017 ◽

Vol 1 (Issue 1) ◽

Author(s):

Hamidullah Abdumadzhidov ◽

Hayrullah Buranov ◽

Ilkhom Huzhakulov ◽

Ikrom Mirhodzhaev ◽

Sh. Artikov

Keyword(s):

Heart Disease ◽

Tricuspid Valve ◽

Reconstructive Surgery ◽

Tricuspid Regurgitation ◽

Valvular Heart Disease ◽

Heart Defects ◽

Open Heart Surgery ◽

Surgical Correction ◽

Valve Disease ◽

Moderate Degree

Objective:- To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4) years), among them 197 (67.4%) women and 95 (32.6%) - men. According to the degree of circulatory disorders, 21 (7.2%) patients were in NYHA class III- and 271 (92.8%) patients - class IV. Of them 235 (80.5%) patients were operated by the method of De Vega using plastic fibrous ring.- After tricuspid valve (TV) and fibrous ring repair- in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had- 2nd- (moderate) degree tricuspid regurgitation. In 7 (2.38%) cases of infective endocarditis, the "open heart surgery" correction - replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases. -------- Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation- and- reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.

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40 Long-term clinical outcome of functional tricuspid regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.002 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

D Mutlak ◽

J Lessick ◽

Y Agmon ◽

D Aronson

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Propensity Score ◽

Clinical Outcome ◽

Propensity Score Matching ◽

Cardiovascular Mortality ◽

Tricuspid Regurgitation ◽

Left Ventricular ◽

Functional Tricuspid Regurgitation ◽

Interaction Plot

Abstract Background Significant functional tricuspid regurgitation (TR) has been associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and to clinical outcome. Methods We studied 5886 patients who were followed for a period of 10-years after the index echocardiographic examination. The relationship between TR severity and the composite endpoint of admission for heart failure or cardiovascular mortality was analyzed using a Cox model. An additional analysis included a propensity-score-matching. To simplify the modeling of the severity of LHD, we calculated an additive score summing the number of LHD components as follows: reduced LVEF, LA enlargement ≥moderate, aortic or mitral valve disease (regurgitation or stenosis ≥moderate) and PASP≥50 mmHg. Results Higher TR grade was associated with markers of LHD including left ventricular systolic dysfunction, valvular heart disease ≥moderate, left atrial enlargement and pulmonary hypertension (All P < 0.001). There was a significant interaction between TR and the presence of LHD with regard to the endpoint of heart failure in the model for admission for heart failure (P = 0.01) and the combined endpoint of heart failure and cardiovascular mortality (P = 0.02). In both models, moderate/severe TR was associated with higher risk for heart failure (hazard ratio [HR] 3.13; 95% CI 2.49–3.93, P < 0.0001) and the combined endpoint of heart failure or cardiovascular mortality (HR 2.61; 95% CI 1.33–5.13, P = 0.005) only in patients without LHD. The interaction plot (Figure) demonstrates that when LHD is present, TR is not a predictor of clinical outcome. Propensity score matching yielded 350 patient pairs, of which 88% had LHD. The HR for heart failure or cardiovascular mortality at 10-years was 0.78 (95% CI 0.56–1.08, P = 0.14) in the moderate/severe TR as compared with the trivial/mild TR. Conclusions Moderate or severe functional TR portends an increased risk for heart failure and cardiovascular mortality only when isolated, without concomitant LHD. Abstract 40 Figure. Interaction plot

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Heart valve disease: tricuspid valve disease

10.1093/med/9780198726012.003.0037 ◽

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.

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P879 3D transoesophageal echocardiography to asses a case of a non-ebstein tricuspid valve congenital regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.521 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Sanz Ortega ◽

S Velasco Del Castillo ◽

J J Onaindia Gandarias ◽

I Rodriguez Sanchez ◽

J Florido Perena ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Congenital Heart ◽

Volume Overload ◽

Transoesophageal Echocardiography ◽

Ebstein Anomaly ◽

Downward Displacement ◽

And Function

Abstract Introduction Due to the complexity of congenital heart disease and limitations of transthorathic echocardiogram (TTE), especially in adult patients, it is not unusual to need other image techniques to assess cardiac anatomy and function. The most common primary anomaly of tricuspid valve (TV) is Ebstein anomaly, but there are other much rarer primary anomalies of this valve consisting in prolapse, cord retraction.... without downward displacement of the leaflet, generally causing tricuspid regurgitation (TR) that can be severe and sometimes intervention is needed, preferably reparation. Due to anatomical issues, it is difficult to assess anatomy of TV in TTE, so sometimes 3D-TTE must be performed to clarify the mechanism and to measure orifice, but when transthoracic view is not enough, 3D transoesophageal echocardiogram (TOE) can be useful for this purpose. Case We report the case of a 15-year-old boy that was referred to our clinic because of shortness of breath and a systolic tricuspid murmur. TTE was performed and an image compatible with tricuspid valve prolapse with no apical displacement of any leaflets (Figure, A) causing severe TR (Figure, B) was noticed, as well as severely dilated right chambers, with good ejection fraction of both ventricles. It was not clear the mechanism so 2D TOE was done, showing a prolapse of a leaflet (Figure, C) causing severe TR (Figure, D). The mechanism was finally clarified by 3D TOE (figure E). This was a prolapse of lateral portion of posterior leaflet (asterisk) with restrictive movement of anterior (triangle) and septal (arrow) ones, causing a huge coaptation defect in systole leading to a very severe tricuspid insufficiency with signs of volume overload of right ventricle. There was no atrial septal defect and pulmonary drainage anomalies were ruled out by cardiac magnetic resonance. Patient was referred to surgery due to symptoms and great dilatation of right chambers. Conclusión: Due to anatomical complexity and limitations of echography, cross and multimodality cardiac imaging is usually needed in assessing congenital heart disease. Apart from Ebstein anomaly, other congenital entities of tricuspid valve such as prolapse and/or retraction can lead to severe tricuspid regurgitation. Due to limitations of 2D TTE in assessing tricuspid valve anatomy, 3D TTE has to be performed, but if it is not enough, 3D TOE can be an option to evaluate mechanism and directly see the orifice of regurgitation in congenital disease of tricuspid valve. Abstract P879 Figure

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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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5940Right ventricular reverse remodeling occurs early after transcatheter tricuspid valve repair for isolated severe tricuspid regurgitation and is associated with better outcome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0090 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Orban ◽

L Stolz ◽

D Braun ◽

T Stocker ◽

K Stark ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcome ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Significant Trend ◽

Tricuspid Valve Repair ◽

Tricuspid Annulus ◽

Valve Repair ◽

Severe Tricuspid Regurgitation

Abstract Background Transcatheter edge-to-edge tricuspid valve repair (TTVR) is a novel treatment option in patients with severe tricuspid regurgitation (TR), right-sided heart failure and prohibitive surgical risk. Purpose We investigated whether RVRR can occur early after TTVR in patients with isolated TR and its potential association with clinical outcome. Method We measured right ventricular parameters by transthoracic echocardiography (TTE) at baseline (BL) in 44 consecutive patients undergoing TTVR for isolated severe TR. We obtained follow-up (FU) TTEs after 1 month. Results At BL, we observed dilated RVs with an RV end-diastolic area (RVEDA) of 28.0±8.3cm2, RV mid diameter of 40.7±7.3mm and tricuspid annulus of 47.5±8.1mm. The majority of patients (63%) showed RV systolic dysfunction with either a tricuspid annular plane excursion (TAPSE) <17mm or fractional area change (FAC) <35%. In 40 Patients (90%), a periprocedural TR reduction by at least 1 degree was achieved (p<0.01). During further clinical FU (272±183 days), 21 patients died (of whom 14 had prior hospitalizations for heart failure before death), 8 patients had hospitalizations for heart failure, 1 patient underwent heart transplantation and 1 patient was lost to clinical FU. We acquired a short-term echocardiographic follow-up (Echo-FU) after 30 days in 36 patients (82%). TR reduction was stable after 1 month with a TR grade ≤2+ in 26 of 36 patients (72%, p<0.01 vs BL). We detected RVRR in the majority of patients with 1-month Echo-FU: RVEDA decreased from 28.8±8.2 to 26.3±7.4cm2 (p<0.01), RV mid diameter from 41.2±7.3 to 38.5±7.7mm (p<0.01) and tricuspid annulus from 48.3±8.3 to 42.8±6.6mm (Figure, p<0.01). We observed a non-significant trend towards reduction of TAPSE (17.5mm to 16.1 mm, p=0.12) and FAC (37.8% to 35.5%, p=0.17), which could represent a normalization of systolic function of a previously hyperactive RV. Next, we evaluated whether RVRR is potentially associated with clinical outcome. We stratified patients into two groups with more or less than median change in RVEDA, RV mid diameter and TV annulus. Fewer combined clinical events (time to death or repeat intervention or first hospitalization for heart failure) were observed in patients with pronounced decrease of RV mid diameter (p=0.03) and TV annulus (Figure, p=0.02) at FU. A decrease of RVEDA showed a non-significant trend towards better outcome (p=0.06). Figure 1 Conclusions Our report demonstrates that RVRR occurs already 1 month after TTVR for isolated TR and is associated with less clinical endpoints.

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Tricuspid regurgitation secondary to mitral valve disease Tricuspid annulus function as guide to tricuspid valve repair

Cardiovascular Surgery ◽

10.1016/s0967-2109(00)00147-2 ◽

2001 ◽

Vol 9 (4) ◽

pp. 369-377 ◽

Cited By ~ 86

Author(s):

T Colombo

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Disease ◽

Valve Disease ◽

Tricuspid Valve Repair ◽

Tricuspid Annulus ◽

Valve Repair

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Traumatic avulsion of the tricuspid valve after gas bottle explosion

Echo Research and Practice ◽

10.1530/erp-16-0014 ◽

2016 ◽

Vol 3 (2) ◽

pp. K21-K24

Author(s):

Francesca Tedoldi ◽

Maximilian Krisper ◽

Clemens Köhncke ◽

Burkert Pieske

Keyword(s):

Heart Failure ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Right Heart Failure ◽

Severe Illness ◽

List Type ◽

Right Heart ◽

The Right

SummaryWe present a very rare example of chronic right heart failure caused by torrent tricuspid regurgitation. Massive right heart dilatation and severe tricuspid regurgitation due to avulsion of the tricuspid valve apparatus occurred as a result of a blunt chest trauma following the explosion of a gas bottle 20 years before admission, when the patient was a young man in Vietnam. After this incident, the patient went through a phase of severe illness, which can retrospectively be identified as an acute right heart decompensation with malaise, ankle edema, and dyspnea. Blunt chest trauma caused by explosives leading to valvular dysfunction has not been reported in the literature so far. It is remarkable that the patient not only survived this trauma, but had been managing his chronic heart failure well without medication for over 20 years.Learning pointsThorough clinical and physical examination remains the key to identifying patients with relevant valvulopathies.With good acoustic windows, TTE is superior to TEE in visualizing the right heart.Traumatic avulsion of valve apparatus is a rare but potentially life-threatening complication of blunt chest trauma and must be actively sought for. Transthoracic echocardiography remains the method of choice in these patients.

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