scholarly journals Physical activity tracking in correlation to conventional heart failure monitoring assessing improvements after transcatheter mitral and tricuspid valve repair

2019 ◽  
Vol 21 (7) ◽  
pp. 943-945
Author(s):  
Thomas J. Stocker ◽  
Felicitas Scheck ◽  
Mathias Orban ◽  
Daniel Braun ◽  
Helene Hertell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Activity Tracking ◽  
Failure Monitoring ◽  
Heart Failure Monitoring

scholarly journals Prognostic significance of the get with the guidelines-heart failure (GWTG-HF) risk score in patients undergoing trans-catheter tricuspid valve repair (TTVR)

2021 ◽  
Author(s):  
Refik Kavsur ◽  
Hannah Emmi Hupp-Herschel ◽  
Atsushi Sugiura ◽  
Tetsu Tanaka ◽  
Can Öztürk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Mitral Regurgitation ◽  
Risk Stratification ◽  
Tricuspid Valve ◽  
Risk Score ◽  
Left Ventricular Ejection ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Get With The Guidelines

AbstractThe Get-With-The-Guidelines-Heart-Failure (GWTG-HF) score is a risk assessment tool to predict mortality in patients with heart-failure (HF). We aimed to evaluate the GWTG-HF score for risk stratification in HF patients with tricuspid regurgitation undergoing trans-catheter tricuspid valve repair (TTVR). In total, 181 patients who underwent TTVR via edge-to-edge repair (86%) or annuloplasty (14%) were enrolled. Patients were categorized into a low- (≤ 43 points), intermediate- (44–53 points) and high-risk score groups (≥ 54 points). TTVR led to an improvement of TR (p < 0.0001) and NYHA (p < 0.0001). Kaplan–Meier analysis and log-rank test revealed that higher GWTG-HF scores were associated with reduced rates of event-free survival regarding mortality (96% vs 89% vs 73%, respectively, p = 0.001) and hospitalization for heart failure (HHF) (89% vs 86% vs 74%, respectively, p = 0.026). After adjusting for important variables like renal function, left ventricular ejection fraction and mitral regurgitation, the GWTG-HF score remained an independent predictor of the composite endpoint of HHF or mortality (hazard ratio 1.04 per 1-point increase, p = 0.029). Other remaining predictors were renal function and mitral regurgitation. The GWTG-HF score used as a risk stratification tool of mortality and HHF maintains its prognostic value in a HF population with severe TR undergoing TTVR.

Concomitant Tricuspid Valve Repair in Patients Undergoing LVAD Placement Reduces Incidence of Acute Right Heart Failure

2013 ◽  
Vol 32 (4) ◽  
pp. S55-S56
Author(s):  
L.E. Rodriguez ◽  
B.A. Bruckner ◽  
T. Motomura ◽  
J.D. Estep ◽  
B. Trachtenberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Right Heart Failure ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Right Heart

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

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.

P4717Clinical impact of elevated tricuspid valve gradient after transcatheter tricuspid valve repair

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Orban ◽  
M W Orban ◽  
D Braun ◽  
S Deseive ◽  
D Kupka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Nyha Class ◽  
Patient Characteristics ◽  
Walking Distance ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Clinical Endpoints ◽  
Heart Failure Questionnaire ◽  
One Year

Abstract Background Transcatheter edge-to-edge tricuspid valve repair (TTVR) is a novel treatment approach in heart failure patients with moderate-to-severe tricuspid regurgitation (TR) at prohibitive surgical risk. Aim The aim of this study was to investigate the mean tricuspid valve gradient (TVG) over time and compare patient characteristics and outcome of patients with a post-procedure TVG of >3 mmHg vs. ≤3 mmHg. Methods All patients who were treated between between March 2016 and October 2018 with TTVR were included in this analysis. Trans-thoracic echocardiographic assessment of TVG was performed pre-procedurally, pre-discharge, after 1, 6, and 12 month. Results We treated 145 consecutive patients with moderate-to-severe secondary TR with TTVR. Patients were treated with TTVR for severe TR alone (70 patients) or in combination with mitral valve repair for concomitant severe mitral regurgitation and severe or moderate-severe TR with significant annulus dilatation (75 patients). One clip was implanted in 17 (11.7%), 2 clips in 83 (57.2%), 3 clips in 40 (27.6%) and 4 clips in 4 patients (2.8%). Reduction of at least 1 degree of TR was achieved in 136 Patients (93.8%). The median baseline TVG of all patients was 1 mmHg [Inter Quarter Range, IQR 1.0–1.4 mmHg]. The median TVG – measured at post-procedural trans-thoracic echocardiogram pre-discharge – increased to 2 mmHg [IQR, 1.6–3.0 mmHg] and remained constant up to 12 month (2.0 mmHg [IQR 1.0–2.0 mmHg). Of these, twenty-five patients showed an elevated TVG >3 mmHg post-procedurally. Patients with TVG >3 mmHg were younger (73.1±11.0 vs. 77.5±9.2 years, p=0.038) and presented with lower levels of pro-BNP at baseline (median 2276 ng/l [IQR, 906–5150] vs. 4182 ng/l [2310–8629], p=0.008) compared to patients with TVG ≤3mmHg. All other baseline characteristics were balanced. There were no differences in procedural success (TR reduction of ≥1 grade in 96% vs. 93.3%, p=0.946) and number of clips implanted (p=0.697). At one month follow-up there were no differences in NYHA class (NYHA class ≥3 in 24% vs. 30.8%, p=0.559), quality of life measured with the Minnesota Living With Heart Failure questionnaire (32.0±22.9 vs. 31.1±16.3, p=0.833), 6 minute walking distance (255.5±140.6 vs. 250.5±111.7 metre, p=0.872). The clinical endpoints 1-year mortality (HR 1.07; 95% CI [0.43–2.65], p=0.88) and the combined endpoint mortality and hospitalization for heart failure at one year (HR 1.07; 95% CI [0.46 to 2.48], p=0.88, see Figure) did not differ between patients with a TVG >3 mmHg vs. patients with a TVG ≤3mmHg. Figure 1 Conclusion TTVR results in a small increase in the tricuspid valve gradient, which remains constant up to one year. A small cohort of patients shows an elevated TVG higher than 3 mmHg after the procedure. This elevation has no impact on NYHA class at 1 month and the clinical endpoints mortality and hospitalization for heart failure at 1 year.

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