scholarly journals Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement

2021 ◽  
Vol 8 ◽  
Author(s):  
Cora Garcia-Ribas ◽  
Mirea Ble ◽  
Miquel Gómez ◽  
Aleksandra Mas-Stachurska ◽  
Núria Farré-López ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Mortality Risk ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Long Term Outcome ◽  
Intermediate Group

Background: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s).Methods: Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm2 and right ventricle/left ventricle ratio>1 as additional echocardiographic variables.Results: In patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, p = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, p = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 p = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, p = 0.07) for guidelines threshold.Conclusion: A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.

Abstract 12967: Efficacy of Combining Assessment of Right Ventricular Function and Right Atrial Remodeling as Prognostic Factor in Patients With Pulmonary Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuko Fukuda ◽  
Hidekazu Tanaka ◽  
Yoshiki Motoji ◽  
Keiko Ryo ◽  
Hiroki Matsuzoe ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
World Health ◽  
Right Atrial ◽  
Atrial Remodeling ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Longitudinal Strains ◽  
Rv Function

Background: Since survival of patients with pulmonary hypertension (PH) is closely related to right ventricular (RV) function, assessment of RV function is important for patients with PH. Right atrial (RA) area and/or RA pressure have also been reported to serve as prognostic predictors for adverse outcomes for in PH patient. Accordingly, we tested the hypothesis that the addition of RA remodeling to RV function enhances the capability of the latter to predict long-term outcome for PH patients. Methods: We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free≤19.4% and RA area of >18cm2, respectively. Long-term unfavorable outcome events were tracked for 2.0 years. Results: RA area correlated with mean RA pressure (r=0.62, p<0.001), as well as with tricuspid E/E’ (r=0.38, p=0.001). However, RA area with RV restrictive filling was significantly larger than with others (all p<0.05). Kaplan-Meier analysis revealed that patients with RV-free ≤19.4% had worse long-term outcomes than those with RV-free >19.4% (log-rank p=0.01), as did patients with RA area>18cm2 compared with those with RA area ≤18cm2 (log-rank p<0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 =3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 =9.24; p<0.05), and RV-free (χ2 =17.11; p=0.005), and further improved by addition of RA area (χ2 =21.36, p<0.05). Conclusions: The combined assessment of RV function and RA remodeling results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.

scholarly journals Impact of Pulmonary Hypertension on Long-Term Outcome in Patients with Severe Aortic Stenosis

2017 ◽  
Vol 9 (3) ◽  
pp. 241
Author(s):  
Y. Bohbot ◽  
F. Levy ◽  
K. Sanhadji ◽  
D. Rusinaru ◽  
A. Ringle ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Haemodynamic mechanisms and long-term prognostic impact of pulmonary hypertension in patients with severe aortic stenosis undergoing valve replacement

2018 ◽  
Vol 21 (2) ◽  
pp. 172-181 ◽  
Author(s):  
Lukas Weber ◽  
Hans Rickli ◽  
Philipp K. Haager ◽  
Lucas Joerg ◽  
Daniel Weilenmann ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Prognostic Impact

Abstract 1565: Characterization and Outcome of Patients with Severe Symptomatic Aortic Stenosis Referred for Percutaneous Aortic Valve Replacement

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir R Kapadia ◽  
Lars Svensson ◽  
Sachin Goel ◽  
Lee Wallace ◽  
Leonardo Rodriguez ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Medical Management ◽  
Term Outcome ◽  
Long Term Outcome ◽  
All Cause Mortality

Introduction: Although severe symptomatic aortic stenosis (AS) is associated with poor long-term outcome without aortic valve replacement (AVR), many patients are considered high risk for AVR surgery. These patients are typically not referred to cardiac surgery and therefore remain ill defined. Many of these patients are now referred for possible percutaneous AVR (percAVR). We report the clinical and echocardiographic characteristics of these patients with their outcome. Methods: All patients screened for percAVR between 2/06 to 3/07 were studied. Clinical and echocardiographic characteristics of patients undergoing surgical AVR (sAVR), percAVR, balloon aortic valvuloplasty (BAV) and medical management were compared. Clinical follow-up was performed for all cause mortality. Patients that were bridged to sAVR or percAVR after BAV were included in the respective groups. Results: We screened 92 pts for consideration of percAVR at our institution in 1 year. Of these, 19 pts underwent surgical AVR, 18 patients percAVR and 36 patients had medical management without BAV. BAV was performed in 30 patients of which 8 pts underwent percAVR and 3 had sAVR. Most common reasons for medical management included death while being screened (n=10, 28%), patient not interested in the study (n=10, 28%) and questionable severity of symptoms or AS (n=9, 25%). BAV was used in patients that could not wait for percAVR to become available with an intention to bridge. This could not be accomplished in 9 (45%) pts due to death while waiting for percAVR, 4 (20%) pts doing well after BAV not wanting percAVR, and the remaining 6 (30%) pts with exclusion from the current percAVR protocol (e.g. age, bleeding, infection, etc). Conclusion: Symptomatic patients with severe AS have high mortality if AVR is not feasible in a timely manner. About one fifth of the patients referred for percAVR could undergo sAVR with good outcome. Patients managed medically or with BAV alone have unfavorable outcomes. Characteristics and Outcome of Screened Patients

scholarly journals Impact of pulmonary hypertension on long-term outcome in patients with severe aortic stenosis

2017 ◽  
Vol 19 (5) ◽  
pp. 553-561 ◽  
Author(s):  
Franck Levy ◽  
Yohann Bohbot ◽  
Khalil Sanhadji ◽  
Dan Rusinaru ◽  
Anne Ringle ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Acute and Long-Term Hemodynamic Effects of MitraClip Implantation on a Preexisting Secondary Right Heart Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
M. Hünlich ◽  
E. Lubos ◽  
B. E. Beuthner ◽  
M. Puls ◽  
A. Bleckmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Tricuspid Regurgitation ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Right Heart ◽  
Artery Pressure

Positive results of MitraClip in terms of improvement in clinical and left ventricular parameters have been described in detail. However, long-term effects on secondary pulmonary hypertension were not investigated in a larger patient cohort to date. 70 patients with severe mitral regurgitation, additional pulmonary hypertension, and right heart failure as a result of left heart disease were treated in the heart centers Hamburg and Göttingen. Immediately after successful MitraClip implantation, a reduction of the RVOT diameter from 3.52 cm to 3.44 cm was observed reaching a statistically significant value of 3.39 cm after 12 months. In contrast, there was a significant reduction in the velocity of the tricuspid regurgitation (TR) from 4.17 m/s to 3.11 m/s, the gradient of the TR from 48.5 mmHg to 39.3 mmHg, and the systolic pulmonary artery pressure (PAPsyst) from 58.6 mmHg to 50.0 mmHg. This decline continued in the following months (Vmax TR 3.09 m/s, peak TR 38.6 mmHg, and PAPsyst 47.4 mmHg). The tricuspid annular plane systolic excursion (TAPSE) increased from 16.5 mm to 18.9 mm after 12 months. MitraClip implantation improves pulmonary artery pressure, tricuspid regurgitation, and TAPSE after 12 months. At the same time, there is a decrease in the RVOT diameter without significant changes in other right ventricular and right atrial dimensions.

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