scholarly journals Right ventricular longitudinal strain predicts survival in patients with functional tricuspid regurgitation

2021 ◽  
Author(s):  
M. Bannehr ◽  
U. Kahn ◽  
J. Liebchen ◽  
M. Okamoto ◽  
V. Hähnel ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Functional Tricuspid Regurgitation

MO742PRELOAD DEPENDENCE OF PULMONARY HAEMODYNAMICS AND RIGHT VENTRICULAR PERFORMANCE: AN ECHOCARDIOGRAPHIC STUDY IN PATIENTS ON HAEMODIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesc Gual-Capllonch ◽  
Fredzzia Graterol ◽  
Jordi Soler Majoral ◽  
Ioana Bancu ◽  
Elena Ferrer-Sistach ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Longitudinal Strain ◽  
Systolic Pulmonary Artery Pressure ◽  
Ventricular Performance ◽  
Fluid Removal ◽  
Functional Tricuspid Regurgitation ◽  
Echocardiographic Study ◽  
Pulmonary Haemodynamics ◽  
Before And After ◽  
Right Ventricular Performance

Abstract Background and Aims Haemodynamic cardiac changes in haemodialysis are associated with adverse cardiovascular outcomes and and they are difficult to measure. Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload-dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD). Methods and results Fifty-three stable patients on chronic HD with LVEF >50% and without heart failure were recruited (mean age 63.0±12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4±0.7l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2±12.6 to 33.7±11.6 mmHg, p<0.001) without modification of non-invasive pulmonary vascular resistance (1.75±0.44 to 1.75±0.40 eWU, p=0.94). Age and drop in the E/e’ ratio were the variables associated with greater reduction in PASP (p=0.022 and p=0.049, respectively). A significant reduction of right chamber sizes was observed, along with a diminution in measures of RV contractility, excluding RV longitudinal strain. Functional tricuspid regurgitation (FTR) diminution was observed in 26% of patients, occurring in every case with more than mild FTR. On multivariate analyses, left atrial size was the only predictor of pulmonary hypertension (defined as SPAP >40 mmHg) (OR 1.29 (1.07–1.56), p=0.006). Conclusion Rapid volemic changes determined by rapid fluid removal during hemodialysis; may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e′ ratio.

scholarly journals Preoperative Right Ventricular Free‐Wall Longitudinal Strain as a Prognosticator in Isolated Surgery for Severe Functional Tricuspid Regurgitation

2021 ◽  
Author(s):  
Minkwan Kim ◽  
Hyun‐Jung Lee ◽  
Jun‐Bean Park ◽  
Jihoon Kim ◽  
Seung‐Pyo Lee ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Unplanned Readmission ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Surgical Timing ◽  
End Point

Background Severe tricuspid regurgitation (TR) should be intervened before the development of irreversible right ventricular (RV) dysfunction. However, current guidelines do not provide criterion related to RV systolic function to guide optimal surgical timing. We investigated the prognostic value of RV longitudinal strain in patients undergoing isolated surgery for severe functional TR. Methods and Results We enrolled 115 consecutive patients (aged 62±10 years; 23.5% men; 62.6% [n=72] with previous left‐sided valve surgery) who underwent isolated surgery for severe functional TR at 2 tertiary centers. Preoperative clinical and echocardiographic parameters, including RV free‐wall longitudinal strain (RVFWSL), were collected. The primary end point was a composite of cardiac death and unplanned readmission attributable to cardiovascular causes 5 years after surgery. Forty patients (34.8%) reached the primary end point during 333 person‐years of follow‐up. There were 11 cardiac deaths and 34 unplanned readmissions attributable to cardiovascular causes, with 5 patients experiencing both. An absolute preoperative RVFWSL <24% was associated with the primary end point (hazard ratio, 2.30; 95% CI, 1.22–4.36; P =0.011), independent of clinical risk factors, including European System for Cardiac Operative Risk Evaluation II and hemoglobin levels. Meanwhile, other conventional echocardiographic measures of RV systolic function were not significant. The addition of an absolute RVFWSL <24% provided incremental prognostic value to the clinical model for predicting the primary end point. Conclusions Preoperative RVFWSL as an indicator of RV dysfunction was an independent prognosticator in patients undergoing isolated surgery for severe functional TR. Thus, preoperative RVFWSL could help determine the optimal surgical timing for severe functional TR.

scholarly journals Right ventricular papillary muscle approximation for functional tricuspid regurgitation associated with severe leaflet tethering†

2017 ◽  
Vol 26 (4) ◽  
pp. 700-702 ◽  
Author(s):  
Goro Matsumiya ◽  
Hiroki Kohno ◽  
Kaoru Matsuura ◽  
Tomoki Sakata ◽  
Yusaku Tamura ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Functional Tricuspid Regurgitation
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