scholarly journals Pre-Procedural Right Ventricular Longitudinal Strain and Post-Procedural Tricuspid Regurgitation Predict Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)

2021 ◽  
Vol 10 (24) ◽  
pp. 5877
Author(s):  
Hazem Omran ◽  
Alberto Polimeni ◽  
Verena Brandt ◽  
Volker Rudolph ◽  
Tanja K. Rudolph ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Heart Team ◽  
Long Term Outcome ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Rv Function

Background: Right ventricular (RV) dysfunction has been linked to worse outcomes in patients undergoing TAVI. Assessment of RV function is challenging due to its complex morphology. RV longitudinal strain (LS) assessed by speckle-tracking echocardiography (STE) is a novel measure that may overcome most of the limitations of conventional echocardiographic parameters of RV function. The aim of current study was to assess the prognostic value of RV LS in patients undergoing TAVI and to assess echocardiographic predictors of long-term mortality. Methods and results: A retrospective analysis of all consecutive patients who underwent TAVI at our hospital between 1 January 2015 and 1 June 2016. Indication for TAVI was approved by a local heart-team. Echocardiographic data at baseline and after TAVI were re-analyzed and RV LS was measured in all patients with adequate image quality. A total of 229 patients were included in our study (mean age 83.8 ± 5 years, 62% women, mean EuroSCORE II 5.7 ± 5%). All-cause mortality occurred in 17.3% over a mean follow-up of 929 ± 373 days. In multivariate analysis, only baseline average RV free-wall LS (HR 1.05, 95% CI (1.01 to 1.10), p = 0.049) and more than mild tricuspid valve regurgitation (TR) after TAVI (HR 4.39, 95% CI (2.22 to 8.70), p < 0.001) independently increased the risk of all-cause mortality at long- term follow-up (2.5 years), while conventional echocardiographic parameters of RV function did not predict mortality. Conclusion: Pre-procedural RV LS and post-procedural tricuspid regurgitation significantly predicted long-term all-cause mortality in patients undergoing TAVI while conventional echocardiographic parameters of RV function failed in predicting long-term outcome. RV longitudinal strain by STE should be considered in the routine echocardiographic assessments of patients with severe AS.

Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318482
Author(s):  
Thomas J Cahill ◽  
Anthony Prothero ◽  
Jo Wilson ◽  
Andrew Kennedy ◽  
Jacob Brubert ◽  
...  
Keyword(s):  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Valvular Heart Disease ◽  
Surgical Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Age Dependent ◽  
Study Population

ObjectiveThe study aims were (1) to identify the community prevalence of moderate or greater mitral or tricuspid regurgitation (MR/TR), (2) to compare subjects identified by population screening with those with known valvular heart disease (VHD), (3) to understand the mechanisms of MR/TR and (4) to assess the rate of valve intervention and long-term outcome.MethodsAdults aged ≥65 years registered at seven family medicine practices in Oxfordshire, UK were screened for inclusion (n=9504). Subjects with known VHD were identified from hospital records and those without VHD invited to undergo transthoracic echocardiography (TTE) within the Oxford Valvular Heart Disease Population Study (OxVALVE). The study population ultimately comprised 4755 subjects. The severity and aetiology of MR and TR were assessed by integrated comprehensive TTE assessment.ResultsThe prevalence of moderate or greater MR and TR was 3.5% (95% CI 3.1 to 3.8) and 2.6% (95% CI 2.3 to 2.9), respectively. Primary MR was the most common aetiology (124/203, 61.1%). Almost half of cases were newly diagnosed by screening: MR 98/203 (48.3%), TR 69/155 (44.5%). Subjects diagnosed by screening were less symptomatic, more likely to have primary MR and had a lower incidence of aortic valve disease. Surgical intervention was undertaken in six subjects (2.4%) over a median follow-up of 64 months. Five-year survival was 79.8% in subjects with isolated MR, 84.8% in those with isolated TR, and 59.4% in those with combined MR and TR (p=0.0005).ConclusionsModerate or greater MR/TR is common, age-dependent and is underdiagnosed. Current rates of valve intervention are extremely low.

P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nam-Jun Cho ◽  
Soon hyo Kwon ◽  
Bo Da Nam ◽  
Kyoungin Choi
Keyword(s):  
Coronary Artery ◽  
Kidney Disease ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adjusted Risk ◽  
Attenuation Index ◽  
All Cause Mortality ◽  
Long Term Mortality

Abstract Background and Aims Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown. Method This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters. Results Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09). Conclusion The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.

scholarly journals Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function

2017 ◽  
Vol 14 (2) ◽  
pp. 19-24
Author(s):  
Bishal KC ◽  
Rabi Malla ◽  
Ram Kishore Shah ◽  
Anish Hirachan ◽  
Binay Kumar Rauniyar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Clinical Symptoms ◽  
Longitudinal Velocity ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Tei Index ◽  
Long Term Outcome ◽  
Rv Function

Background and Aims: Abnormal Right Ventricular (RV) function affects the long term outcome and clinical symptoms in patients with mitral stenosis (MS). This study evaluates the immediate effect of Percutaneous Transmitral Commisurotomy (PTMC) on RV function.Methods: An observational, cross sectional study was done on 50 patients with rheumatic MS who underwent PTMC at Shahid Gangalal National Heart Center from Dec 2015 –Dec 2016. All underwent clinical evaluation and echocardiogram before and immediately after PTMC.Results: There was female preponderance with 66% being female. The mean age was 37.26 ± 10.63 years. There was immediate increase in the mitral valve area (MVA) from 0.87 ± 0.12cm2 to 1.54 ± 0.27cm2(p< 0.001). There was significant decrease in mean mitral diastolic gradient from 16.4 ± 8.8mmHg to 5 ± 1.5mmHg (p< 0.001), in the pulmonary artery systolic pressure 53.6 ± 21.83mmHg to 39.5 ± 14.67mmHg (p< 0.001), in the RV Tei index from 0.56 ± 0.08 to 0.40 ± 0.08 (p< 0.001). There was significant increase in TAPSE from 16.0 ± 1.50 to 18.6 ± 1.70 mm, (p<0.001) and the longitudinal velocity of excursion of the RV at the tricuspid annulus (RV S’) from 13.69 ± 3.33 cm/sec to 15.31 ± 3.07 cm/sec (p< 0.001)Conclusions: Successful PTMC can improve RV function as shown by the improvement in PASP, RV Tei index, TAPSE and RV S’. Further larger population studies are required to confirm the findings. Long term studies are important to determine the prognostic significance of improvement in RV function.Nepalese Heart Journal 2017; 14(2): 19-24

scholarly journals Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

2020 ◽  
Author(s):  
Chuan-Tsai Tsai ◽  
Wei-Chieh Huang ◽  
Hsin-I Teng ◽  
Yi-Lin Tsai ◽  
Tse-Min Lu
Keyword(s):  
Diabetes Mellitus ◽  
Cox Regression ◽  
Total Occlusion ◽  
Long Term Outcome ◽  
Chronic Total Occlusions ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Diabetes Patients

Abstract Background Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. Methods and results From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1–10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (Hazard ratio (HR):0.593, 95% confidence interval (CI): 0.349–0.008, P:0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI: 0.156–0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI: 0.095–0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn’t improve outcomes in non-diabetics (all p > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI: 0.125–0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI: 0.142–0.851, P: 0.021). Conclusion Successful CTO revascularization was associated with reduced long term all-cause/cardiovascular mortality in diabetics but not in non-diabetic population.

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).

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.

Long-term outcome after atrial correction for transposition of the great arteries

Heart ◽  
2018 ◽  
Vol 105 (10) ◽  
pp. 790-796 ◽  
Author(s):  
Lotte E Couperus ◽  
Hubert W Vliegen ◽  
Tjitske E Zandstra ◽  
Philippine Kiès ◽  
Monique R M Jongbloed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmia ◽  
Functional Class ◽  
Adult Patients ◽  
Adult Survival ◽  
Term Survival ◽  
Long Term Outcome ◽  
Rv Function

ObjectiveThis study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).MethodsIn 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods: early (<15 years postoperatively), midterm (15–30 years postoperatively) and late (>30 years postoperatively).ResultsThe Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (IQR: 2.1–3.8) and 1.0 (IQR: 0.6–3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (IQR: 35.9–42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (OR: 4.47, 95% CI 1.50 to 13.28, p<0.01; OR: 3.74, 95% CI 1.26 to 11.14, p=0.02; OR: 14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (OR: 2.10, 95% CI 0.75 to 5.82, p=0.16; OR: 2.87, 95% CI 1.06 to 7.81, p=0.04; OR: 8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).ConclusionsIn adult patients with TGA, survival was 82% at 39.7 (IQR: 35.9–42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.

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