Right Ventricle Longitudinal Strain: A New Tool in Functional Tricuspid Regurgitation Prognostication

2021 ◽  
Author(s):  
Magdi Hassanin ◽  
Géraldine Ong ◽  
Kim A. Connelly
Keyword(s):  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Functional Tricuspid Regurgitation

P3367Echocardiographic assessment of right ventricle function in patients with severe tricuspid regurgitation and correlates with outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Gavazzoni ◽  
E V Vizzardi ◽  
A C Castiello ◽  
R R Raddino ◽  
L P B Badano ◽  
...  
Keyword(s):  
Heart Disease ◽  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Free Wall ◽  
Severe Tricuspid Regurgitation ◽  
Rv Function

Abstract Background/Introduction Speckle tracking echocardiography has been recently proposed as an accurate and sensitive measure of right ventricle (RV) function that could integrate other more conventional parameters. This tool can be important in the clinical context of severe tricuspid regurgitation (TR), since TAPSE is not fully representative of global RV function and can overestimate this in presence of severe TR. Purpose Evaluate the prognostic relevance of different parameters of RV structure and function derived from 2D and speckle tracking echocardiographic analysis of clinically stable patients with severe TR referred for routine follow up in the context of many etiologies of left side heart disease (secondary TR). Methods The present is a retrospective analysis of prospectively acquired echocardiographic studies including patients with severe secondary TR in the context of left side heart disease. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVLS) and RV free-wall longitudinal strain (RVFWLS) as well as LV function were measured. As suggested in previous studies, we also aimed to explored the use in this population of: i)RVLS/pulmonary systolic arterial pressure (PASP); ii) RVFWLS (average lateral 3 segments strain)/IVSLS (average medial 3 segment strain) as index of RV-LV dependency. The composite end-point of this study included death for any cause and heart failure hospitalization. Results 61 patients (mean age 58±20 years, 65% men), were included. After a mean follow up period of 3,6±2 years 57% of patients reached the combined end-point. At Cox regression univariate analysis a significant correlation with outcomes was found for RVend-diastolic diameter (HR 0,42, p: 0.018), right atrial area (HR: 3, p: 0.02), RVFWLS/IVSLS (HR: 0.5, p: 0.020), RVLS/PASP (HR 0.186, p: 0.039). In multivariable Cox-regression model we found that LVEF, RV dimension and RVFWLS/IVSLS were independently related to outcome; this last one parameter showed the best correlation with outcomes. Conclusions In asymptomatic and clinically stable patients with severe secondary TR longitudinal function of RV free wall is not related to outcomes but RV-arterial coupling and the ratio between deformation of free wall and septal wall of RV are good predictors of clinical deterioration at follow up. The last one conceptually represents the interaction between RV and LV in secondary TR and allows a real “correction” of those effects of severity of TR on the base to apex gradient of lateral wall longitudinal deformation (TR increases movement of basal segments).

Full Orifice Patching without Annuloplasty for Severe Functional Tricuspid Valve Regurgitation

2018 ◽  
Vol 66 (07) ◽  
pp. 572-574 ◽  
Author(s):  
Carlo De Filippo ◽  
Antonio Totaro ◽  
Piero Pelini ◽  
Michele Mauro ◽  
Antonio Calafiore
Keyword(s):  
Surgical Treatment ◽  
Right Ventricle ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Regurgitation ◽  
Midterm Results ◽  
Tricuspid Valve Regurgitation ◽  
Functional Tricuspid Regurgitation ◽  
Tissue Augmentation

AbstractSurgical treatment of severe functional tricuspid regurgitation associated with dilated right ventricle and increased chordal tethering (>8 mm) is challenging. We designed a technique where the anterior and posterior leaflets are detached from 50% of the annulus and a patch as large as the tricuspid orifice is sewn to augment the leaflets' tissue to force the coaptation with the septal leaflet. Annuloplasty is not performed, as it can only increase the chordal tethering, reducing the benefit of tissue augmentation. Early and midterm results in a subgroup of patients with unfavorable anatomical aspects are encouraging.

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.

Right Ventricle and Functional Tricuspid Regurgitation: An Unpredictable Interaction

2014 ◽  
pp. 173-184
Author(s):  
Michele Di Mauro ◽  
Angela L. Iacò ◽  
Ali Own ◽  
Daniela Clemente ◽  
Antonio M. Calafiore
Keyword(s):  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Functional Tricuspid Regurgitation

Functional tricuspid regurgitation and the right ventricle: what we do not know is more than we know

2012 ◽  
Vol 10 (11) ◽  
pp. 1351-1366 ◽  
Author(s):  
Antonio Maria Calafiore ◽  
Giovanni Bartoloni ◽  
Hussein Al Amri ◽  
Angela Lorena Iacò ◽  
Walid Abukhudair ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Functional Tricuspid Regurgitation ◽  
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