Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?
A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease. We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction. This was...
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| Veröffentlicht in: | Archives of cardiovascular diseases 2021-04, Vol.114 (4), p.277-286 |
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| creator | Guérin, Anne Vabret, Elsa Dreyfus, Julien Lavie-Badie, Yoan Sportouch, Catherine Eicher, Jean-Christophe Maréchaux, Sylvestre Le Tourneau, Thierry Donal, Erwan |
| description | A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease.
We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction.
This was a prospective observational multicentre study. Patients with severe tricuspid regurgitation were asked to participate in a registry that required a control echocardiogram after optimization of medical treatment and a follow-up. Patients had to have at least mild secondary tricuspid regurgitation when clinically stable, and were classified according to five grades of tricuspid regurgitation severity, based on effective regurgitant orifice area.
One hundred patients with tricuspid regurgitation (12 mild, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled. Right atrial indexed volume and tethering area were statistically associated with the degree of tricuspid regurgitation (P70%. For an increase of 10mL/m2 in right atrial volume, the effective regurgitant orifice area increased by 4.2mm2, and for an increase of 0.1cm2 in the tethering area, the effective regurgitant orifice area increased by 2.35mm2. The degree of right ventricular dilation and changes in tricuspid morphology were significantly related to tricuspid regurgitation severity class (P |
| doi_str_mv | 10.1016/j.acvd.2020.11.002 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03583311v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1875213620302631</els_id><sourcerecordid>2478591719</sourcerecordid><originalsourceid>FETCH-LOGICAL-c390t-503b3f32a5ba468f07c8248ac8c68905401f6d2189573d04982c2dfef60c091e3</originalsourceid><addsrcrecordid>eNp9kcGO0zAQhi0EYpeFF-CAfIRDy4ydOA5CQqsKWKRKHICz5dqT1iWJi50U7dvjqkvFiZOt0ff_ludj7CXCEgHV2_3SuqNfChBlgEsA8Yhdo27qhUChH1_uUl2xZznvAZRoGvWUXUlZVapq1DWLK5t8sI4nGqKnvg_jloeRZ3Jx9Dbd8ykFN-dD8AXZzmkbJjuFOL7j33Zx7j3_TbyP8Sff0H1J8GlH_0TsOM79nHl5YqCJ0ofn7Eln-0wvHs4b9uPTx--ru8X66-cvq9v1wskWpkUNciM7KWy9sZXSHTROi0pbp53SLdQVYKe8QN3WjfRQtVo44TvqFDhokeQNe3Pu3dneHFIYyldMtMHc3a7NaQay1lIiHrGwr8_sIcVfM-XJDCG7sgs7UpyzEVWj6xYbbAsqzqhLMedE3aUbwZykmL05STEnKQbRFCkl9Oqhf94M5C-RvxYK8P4MUNnIMVAy2QUaHfmQyE3Gx_C__j82qJ24</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2478591719</pqid></control><display><type>article</type><title>Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?</title><source>Access via ScienceDirect (Elsevier)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Guérin, Anne ; Vabret, Elsa ; Dreyfus, Julien ; Lavie-Badie, Yoan ; Sportouch, Catherine ; Eicher, Jean-Christophe ; Maréchaux, Sylvestre ; Le Tourneau, Thierry ; Donal, Erwan</creator><creatorcontrib>Guérin, Anne ; Vabret, Elsa ; Dreyfus, Julien ; Lavie-Badie, Yoan ; Sportouch, Catherine ; Eicher, Jean-Christophe ; Maréchaux, Sylvestre ; Le Tourneau, Thierry ; Donal, Erwan</creatorcontrib><description>A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease.
We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction.
This was a prospective observational multicentre study. Patients with severe tricuspid regurgitation were asked to participate in a registry that required a control echocardiogram after optimization of medical treatment and a follow-up. Patients had to have at least mild secondary tricuspid regurgitation when clinically stable, and were classified according to five grades of tricuspid regurgitation severity, based on effective regurgitant orifice area.
One hundred patients with tricuspid regurgitation (12 mild, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled. Right atrial indexed volume and tethering area were statistically associated with the degree of tricuspid regurgitation (P<0.001 and P=0.005, respectively). When the tricuspid annular diameter was≥50mm, the probability of having severe tricuspid regurgitation or a higher grade was>70%. For an increase of 10mL/m2 in right atrial volume, the effective regurgitant orifice area increased by 4.2mm2, and for an increase of 0.1cm2 in the tethering area, the effective regurgitant orifice area increased by 2.35mm2. The degree of right ventricular dilation and changes in tricuspid morphology were significantly related to tricuspid regurgitation severity class (P<0.001). No significant difference in right ventricular function variables was observed between the tricuspid regurgitation classes.
For tricuspid regurgitation to be severe or torrential, both right atrial dilatation and leaflet tethering are needed. Interestingly, right cavities dilated progressively with tricuspid regurgitation severity, without joint degradation of right ventricular systolic function variables.
Une meilleure compréhension du mécanisme de la sévérité de la régurgitation tricuspide permettrait d’améliorer la prise en charge de cette pathologie.
Nous avons étudié les déterminants de la sévérité de l’insuffisance tricuspide secondaire chez des patients ayant une fonction ventriculaire gauche préservée.
L’étude est prospective et multicentrique. Les patients ayant une insuffisance tricuspide sévère ont été sollicités afin de participer à un registre justifiant une évaluation échocardiographique systématisée de leur valvulopathie après optimisation de son traitement médical. Les patients inclus devaient avoir au moins une insuffisance tricuspide modérée lors de l’évaluation systématisée. La fuite était caractérisée en 5 grades sur la base de la surface de l’orifice régurgitant.
Cent patients (12 modérée, 31 moyenne, 18 sévère, 17 massive et 22 torrentielle) ont été inclus. Le volume indexé de l’oreillette droite et l’aire sous la tente étaient significativement associés au degré de sévérité de l’insuffisance tricuspide (p<0,001 et p=0,005, respectivement). Si le diamètre de l’anneau était≥50mm, la probabilité d’avoir une insuffisance tricuspide≥sévère était>70 %. Pour une augmentation de 10mL/m2 du volume de l’oreillette droite, la surface de l’orifice régurgitant augmentait de 4,2mm2, et pour une augmentation de 0,1cm2 de l’aire sous la tente, la surface de l’orifice régurgitant augmentait de 2,35mm2. Il n’y avait pas de différence significative entre les paramètres de fonction ventriculaire droite selon le degré de sévérité de l’insuffisance tricuspide.
Pour être sévère ou torrentielle, la dilatation atriale droite et la restriction du jeu valvulaire sont nécessaires. De manière intéressante, la progressive dilatation des cavités droites avec l’aggravation de l’insuffisance tricuspide ne s’accompagne pas d’une altération des paramètres d’évaluation de la fonction du ventricule droit.</description><identifier>ISSN: 1875-2136</identifier><identifier>EISSN: 1875-2128</identifier><identifier>DOI: 10.1016/j.acvd.2020.11.002</identifier><identifier>PMID: 33446476</identifier><language>eng</language><publisher>Netherlands: Elsevier Masson SAS</publisher><subject>Determinant ; Déterminant ; Insuffisance tricuspide ; Life Sciences ; Remodelage du ventricule droit ; Right heart remodelling ; Tricuspid regurgitation</subject><ispartof>Archives of cardiovascular diseases, 2021-04, Vol.114 (4), p.277-286</ispartof><rights>2021 Elsevier Masson SAS</rights><rights>Copyright © 2021 Elsevier Masson SAS. All rights reserved.</rights><rights>Attribution - NonCommercial</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-503b3f32a5ba468f07c8248ac8c68905401f6d2189573d04982c2dfef60c091e3</citedby><cites>FETCH-LOGICAL-c390t-503b3f32a5ba468f07c8248ac8c68905401f6d2189573d04982c2dfef60c091e3</cites><orcidid>0000-0001-9687-0518 ; 0000-0003-2677-3389 ; 0000-0002-9083-1582</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.acvd.2020.11.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33446476$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://u-picardie.hal.science/hal-03583311$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Guérin, Anne</creatorcontrib><creatorcontrib>Vabret, Elsa</creatorcontrib><creatorcontrib>Dreyfus, Julien</creatorcontrib><creatorcontrib>Lavie-Badie, Yoan</creatorcontrib><creatorcontrib>Sportouch, Catherine</creatorcontrib><creatorcontrib>Eicher, Jean-Christophe</creatorcontrib><creatorcontrib>Maréchaux, Sylvestre</creatorcontrib><creatorcontrib>Le Tourneau, Thierry</creatorcontrib><creatorcontrib>Donal, Erwan</creatorcontrib><title>Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?</title><title>Archives of cardiovascular diseases</title><addtitle>Arch Cardiovasc Dis</addtitle><description>A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease.
We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction.
This was a prospective observational multicentre study. Patients with severe tricuspid regurgitation were asked to participate in a registry that required a control echocardiogram after optimization of medical treatment and a follow-up. Patients had to have at least mild secondary tricuspid regurgitation when clinically stable, and were classified according to five grades of tricuspid regurgitation severity, based on effective regurgitant orifice area.
One hundred patients with tricuspid regurgitation (12 mild, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled. Right atrial indexed volume and tethering area were statistically associated with the degree of tricuspid regurgitation (P<0.001 and P=0.005, respectively). When the tricuspid annular diameter was≥50mm, the probability of having severe tricuspid regurgitation or a higher grade was>70%. For an increase of 10mL/m2 in right atrial volume, the effective regurgitant orifice area increased by 4.2mm2, and for an increase of 0.1cm2 in the tethering area, the effective regurgitant orifice area increased by 2.35mm2. The degree of right ventricular dilation and changes in tricuspid morphology were significantly related to tricuspid regurgitation severity class (P<0.001). No significant difference in right ventricular function variables was observed between the tricuspid regurgitation classes.
For tricuspid regurgitation to be severe or torrential, both right atrial dilatation and leaflet tethering are needed. Interestingly, right cavities dilated progressively with tricuspid regurgitation severity, without joint degradation of right ventricular systolic function variables.
Une meilleure compréhension du mécanisme de la sévérité de la régurgitation tricuspide permettrait d’améliorer la prise en charge de cette pathologie.
Nous avons étudié les déterminants de la sévérité de l’insuffisance tricuspide secondaire chez des patients ayant une fonction ventriculaire gauche préservée.
L’étude est prospective et multicentrique. Les patients ayant une insuffisance tricuspide sévère ont été sollicités afin de participer à un registre justifiant une évaluation échocardiographique systématisée de leur valvulopathie après optimisation de son traitement médical. Les patients inclus devaient avoir au moins une insuffisance tricuspide modérée lors de l’évaluation systématisée. La fuite était caractérisée en 5 grades sur la base de la surface de l’orifice régurgitant.
Cent patients (12 modérée, 31 moyenne, 18 sévère, 17 massive et 22 torrentielle) ont été inclus. Le volume indexé de l’oreillette droite et l’aire sous la tente étaient significativement associés au degré de sévérité de l’insuffisance tricuspide (p<0,001 et p=0,005, respectivement). Si le diamètre de l’anneau était≥50mm, la probabilité d’avoir une insuffisance tricuspide≥sévère était>70 %. Pour une augmentation de 10mL/m2 du volume de l’oreillette droite, la surface de l’orifice régurgitant augmentait de 4,2mm2, et pour une augmentation de 0,1cm2 de l’aire sous la tente, la surface de l’orifice régurgitant augmentait de 2,35mm2. Il n’y avait pas de différence significative entre les paramètres de fonction ventriculaire droite selon le degré de sévérité de l’insuffisance tricuspide.
Pour être sévère ou torrentielle, la dilatation atriale droite et la restriction du jeu valvulaire sont nécessaires. De manière intéressante, la progressive dilatation des cavités droites avec l’aggravation de l’insuffisance tricuspide ne s’accompagne pas d’une altération des paramètres d’évaluation de la fonction du ventricule droit.</description><subject>Determinant</subject><subject>Déterminant</subject><subject>Insuffisance tricuspide</subject><subject>Life Sciences</subject><subject>Remodelage du ventricule droit</subject><subject>Right heart remodelling</subject><subject>Tricuspid regurgitation</subject><issn>1875-2136</issn><issn>1875-2128</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kcGO0zAQhi0EYpeFF-CAfIRDy4ydOA5CQqsKWKRKHICz5dqT1iWJi50U7dvjqkvFiZOt0ff_ludj7CXCEgHV2_3SuqNfChBlgEsA8Yhdo27qhUChH1_uUl2xZznvAZRoGvWUXUlZVapq1DWLK5t8sI4nGqKnvg_jloeRZ3Jx9Dbd8ykFN-dD8AXZzmkbJjuFOL7j33Zx7j3_TbyP8Sff0H1J8GlH_0TsOM79nHl5YqCJ0ofn7Eln-0wvHs4b9uPTx--ru8X66-cvq9v1wskWpkUNciM7KWy9sZXSHTROi0pbp53SLdQVYKe8QN3WjfRQtVo44TvqFDhokeQNe3Pu3dneHFIYyldMtMHc3a7NaQay1lIiHrGwr8_sIcVfM-XJDCG7sgs7UpyzEVWj6xYbbAsqzqhLMedE3aUbwZykmL05STEnKQbRFCkl9Oqhf94M5C-RvxYK8P4MUNnIMVAy2QUaHfmQyE3Gx_C__j82qJ24</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Guérin, Anne</creator><creator>Vabret, Elsa</creator><creator>Dreyfus, Julien</creator><creator>Lavie-Badie, Yoan</creator><creator>Sportouch, Catherine</creator><creator>Eicher, Jean-Christophe</creator><creator>Maréchaux, Sylvestre</creator><creator>Le Tourneau, Thierry</creator><creator>Donal, Erwan</creator><general>Elsevier Masson SAS</general><general>Elsevier ; Société française de cardiologie [2008-....]</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0001-9687-0518</orcidid><orcidid>https://orcid.org/0000-0003-2677-3389</orcidid><orcidid>https://orcid.org/0000-0002-9083-1582</orcidid></search><sort><creationdate>20210401</creationdate><title>Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?</title><author>Guérin, Anne ; Vabret, Elsa ; Dreyfus, Julien ; Lavie-Badie, Yoan ; Sportouch, Catherine ; Eicher, Jean-Christophe ; Maréchaux, Sylvestre ; Le Tourneau, Thierry ; Donal, Erwan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-503b3f32a5ba468f07c8248ac8c68905401f6d2189573d04982c2dfef60c091e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Determinant</topic><topic>Déterminant</topic><topic>Insuffisance tricuspide</topic><topic>Life Sciences</topic><topic>Remodelage du ventricule droit</topic><topic>Right heart remodelling</topic><topic>Tricuspid regurgitation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guérin, Anne</creatorcontrib><creatorcontrib>Vabret, Elsa</creatorcontrib><creatorcontrib>Dreyfus, Julien</creatorcontrib><creatorcontrib>Lavie-Badie, Yoan</creatorcontrib><creatorcontrib>Sportouch, Catherine</creatorcontrib><creatorcontrib>Eicher, Jean-Christophe</creatorcontrib><creatorcontrib>Maréchaux, Sylvestre</creatorcontrib><creatorcontrib>Le Tourneau, Thierry</creatorcontrib><creatorcontrib>Donal, Erwan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Archives of cardiovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guérin, Anne</au><au>Vabret, Elsa</au><au>Dreyfus, Julien</au><au>Lavie-Badie, Yoan</au><au>Sportouch, Catherine</au><au>Eicher, Jean-Christophe</au><au>Maréchaux, Sylvestre</au><au>Le Tourneau, Thierry</au><au>Donal, Erwan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter?</atitle><jtitle>Archives of cardiovascular diseases</jtitle><addtitle>Arch Cardiovasc Dis</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>114</volume><issue>4</issue><spage>277</spage><epage>286</epage><pages>277-286</pages><issn>1875-2136</issn><eissn>1875-2128</eissn><abstract>A better understanding of the mechanism of tricuspid regurgitation severity would help to improve the management of this disease.
We sought to characterize the determinants of isolated secondary tricuspid regurgitation severity in patients with preserved left ventricular ejection fraction.
This was a prospective observational multicentre study. Patients with severe tricuspid regurgitation were asked to participate in a registry that required a control echocardiogram after optimization of medical treatment and a follow-up. Patients had to have at least mild secondary tricuspid regurgitation when clinically stable, and were classified according to five grades of tricuspid regurgitation severity, based on effective regurgitant orifice area.
One hundred patients with tricuspid regurgitation (12 mild, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled. Right atrial indexed volume and tethering area were statistically associated with the degree of tricuspid regurgitation (P<0.001 and P=0.005, respectively). When the tricuspid annular diameter was≥50mm, the probability of having severe tricuspid regurgitation or a higher grade was>70%. For an increase of 10mL/m2 in right atrial volume, the effective regurgitant orifice area increased by 4.2mm2, and for an increase of 0.1cm2 in the tethering area, the effective regurgitant orifice area increased by 2.35mm2. The degree of right ventricular dilation and changes in tricuspid morphology were significantly related to tricuspid regurgitation severity class (P<0.001). No significant difference in right ventricular function variables was observed between the tricuspid regurgitation classes.
For tricuspid regurgitation to be severe or torrential, both right atrial dilatation and leaflet tethering are needed. Interestingly, right cavities dilated progressively with tricuspid regurgitation severity, without joint degradation of right ventricular systolic function variables.
Une meilleure compréhension du mécanisme de la sévérité de la régurgitation tricuspide permettrait d’améliorer la prise en charge de cette pathologie.
Nous avons étudié les déterminants de la sévérité de l’insuffisance tricuspide secondaire chez des patients ayant une fonction ventriculaire gauche préservée.
L’étude est prospective et multicentrique. Les patients ayant une insuffisance tricuspide sévère ont été sollicités afin de participer à un registre justifiant une évaluation échocardiographique systématisée de leur valvulopathie après optimisation de son traitement médical. Les patients inclus devaient avoir au moins une insuffisance tricuspide modérée lors de l’évaluation systématisée. La fuite était caractérisée en 5 grades sur la base de la surface de l’orifice régurgitant.
Cent patients (12 modérée, 31 moyenne, 18 sévère, 17 massive et 22 torrentielle) ont été inclus. Le volume indexé de l’oreillette droite et l’aire sous la tente étaient significativement associés au degré de sévérité de l’insuffisance tricuspide (p<0,001 et p=0,005, respectivement). Si le diamètre de l’anneau était≥50mm, la probabilité d’avoir une insuffisance tricuspide≥sévère était>70 %. Pour une augmentation de 10mL/m2 du volume de l’oreillette droite, la surface de l’orifice régurgitant augmentait de 4,2mm2, et pour une augmentation de 0,1cm2 de l’aire sous la tente, la surface de l’orifice régurgitant augmentait de 2,35mm2. Il n’y avait pas de différence significative entre les paramètres de fonction ventriculaire droite selon le degré de sévérité de l’insuffisance tricuspide.
Pour être sévère ou torrentielle, la dilatation atriale droite et la restriction du jeu valvulaire sont nécessaires. De manière intéressante, la progressive dilatation des cavités droites avec l’aggravation de l’insuffisance tricuspide ne s’accompagne pas d’une altération des paramètres d’évaluation de la fonction du ventricule droit.</abstract><cop>Netherlands</cop><pub>Elsevier Masson SAS</pub><pmid>33446476</pmid><doi>10.1016/j.acvd.2020.11.002</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9687-0518</orcidid><orcidid>https://orcid.org/0000-0003-2677-3389</orcidid><orcidid>https://orcid.org/0000-0002-9083-1582</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Determinant Déterminant Insuffisance tricuspide Life Sciences Remodelage du ventricule droit Right heart remodelling Tricuspid regurgitation |
| title | Cardiac remodelling in secondary tricuspid regurgitation: Should we look beyond the tricuspid annulus diameter? |
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