Role of anatomical regurgitant orifice area and right ventricular contractile reserve in severe tricuspid regurgitation

Role of anatomical regurgitant orifice area and right ventricular contractile reserve in severe tricuspid regurgitation

Abstract Aims We sought to propose a novel risk stratification system for severe tricuspid regurgitation (TR) using 3D-anatomical regurgitant orifice area (3D-AROA) and the slope of tricuspid annular plane systolic excursion vs. systolic pulmonary artery pressure (TAPSE/SPAP) and to validate its pro...

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Veröffentlicht in:European heart journal cardiovascular imaging 2022-06, Vol.23 (7), p.989-1000
Hauptverfasser: Utsunomiya, Hiroto, Izumi, Kanako, Tsuchiya, Akane, Mogami, Atsuo, Takahari, Kosuke, Takemoto, Hajime, Ramandika, Erasta, Ueda, Yusuke, Itakura, Kiho, Nakano, Yukiko
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container_issue 7
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container_title European heart journal cardiovascular imaging
container_volume 23
creator Utsunomiya, Hiroto
Izumi, Kanako
Tsuchiya, Akane
Mogami, Atsuo
Takahari, Kosuke
Takemoto, Hajime
Ramandika, Erasta
Ueda, Yusuke
Itakura, Kiho
Nakano, Yukiko
description Abstract Aims We sought to propose a novel risk stratification system for severe tricuspid regurgitation (TR) using 3D-anatomical regurgitant orifice area (3D-AROA) and the slope of tricuspid annular plane systolic excursion vs. systolic pulmonary artery pressure (TAPSE/SPAP) and to validate its prognostic significance. Methods and results Sixty-four patients with severe functional TR (52% torrential) underwent 3D echocardiography and exercise–stress echocardiography. As an estimate of regurgitation severity, 3D-AROA was measured with the customized software package. As an index of right ventricular (RV) contractile reserve, the TAPSE/SPAP slope was calculated by plotting the relationship between TAPSE and SPAP during exercise test. Haemodynamic parameters were obtained by right heart catheterization (RHC). Based on receiver operating characteristics curves, optimal cut-off values of 3D-AROA and TAPSE/SPAP slope to identify all-cause mortality were 161 mm2 and 0.046 mm/mmHg, respectively. During a median follow-up of 559 days, 20 patients (31%) died. After correcting for potential confounders, 3DAROA≥ 161 mm2 (HR 4.37; 95% CI 1.34–14.07; P = 0.015) and TAPSE/SPAP slope≤0.046 mm/mmHg (HR 4.76; 95% CI 1.46–15.53; P = 0.009) were echocardiographic parameters independently associated with all-cause mortality. The cumulative survival rate was lower in patients with 3D-AROA≥161 mm2 and TAPSE/SPAP slope≤0.046 mm/mmHg compared with their counterparts (both P
doi_str_mv 10.1093/ehjci/jeac004
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Methods and results Sixty-four patients with severe functional TR (52% torrential) underwent 3D echocardiography and exercise–stress echocardiography. As an estimate of regurgitation severity, 3D-AROA was measured with the customized software package. As an index of right ventricular (RV) contractile reserve, the TAPSE/SPAP slope was calculated by plotting the relationship between TAPSE and SPAP during exercise test. Haemodynamic parameters were obtained by right heart catheterization (RHC). Based on receiver operating characteristics curves, optimal cut-off values of 3D-AROA and TAPSE/SPAP slope to identify all-cause mortality were 161 mm2 and 0.046 mm/mmHg, respectively. During a median follow-up of 559 days, 20 patients (31%) died. After correcting for potential confounders, 3DAROA≥ 161 mm2 (HR 4.37; 95% CI 1.34–14.07; P = 0.015) and TAPSE/SPAP slope≤0.046 mm/mmHg (HR 4.76; 95% CI 1.46–15.53; P = 0.009) were echocardiographic parameters independently associated with all-cause mortality. The cumulative survival rate was lower in patients with 3D-AROA≥161 mm2 and TAPSE/SPAP slope≤0.046 mm/mmHg compared with their counterparts (both P&lt;0.05). RHC confirmed higher right atrial pressure (P&lt;0.001) and lower cardiac index (P = 0.004) in patients with both 3D-AROA≥161 mm2 and TAPSE/SPAP slope ≤0.046 mm/mmHg. Conclusion Large AROA and reduced RV contractile reserve during exercise are independently associated with poor prognosis. The new grading scheme of severe TR was validated by haemodynamics and may improve risk stratification. Graphical Abstract Graphical Abstract Kaplan–Meier curves for survival in severe tricuspid regurgitation according to a proposed risk stratification system using 3D-AROA and TAPSE/SPAP slope.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jeac004</identifier><identifier>PMID: 35134908</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>European heart journal cardiovascular imaging, 2022-06, Vol.23 (7), p.989-1000</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com. 2022</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-8833d5e628b72b8b4c2f8f18c6aff995f88bd0174b5a77123a0f2e79bb042e583</citedby><cites>FETCH-LOGICAL-c392t-8833d5e628b72b8b4c2f8f18c6aff995f88bd0174b5a77123a0f2e79bb042e583</cites><orcidid>0000-0002-6587-9584</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35134908$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Utsunomiya, Hiroto</creatorcontrib><creatorcontrib>Izumi, Kanako</creatorcontrib><creatorcontrib>Tsuchiya, Akane</creatorcontrib><creatorcontrib>Mogami, Atsuo</creatorcontrib><creatorcontrib>Takahari, Kosuke</creatorcontrib><creatorcontrib>Takemoto, Hajime</creatorcontrib><creatorcontrib>Ramandika, Erasta</creatorcontrib><creatorcontrib>Ueda, Yusuke</creatorcontrib><creatorcontrib>Itakura, Kiho</creatorcontrib><creatorcontrib>Nakano, Yukiko</creatorcontrib><title>Role of anatomical regurgitant orifice area and right ventricular contractile reserve in severe tricuspid regurgitation</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>Abstract Aims We sought to propose a novel risk stratification system for severe tricuspid regurgitation (TR) using 3D-anatomical regurgitant orifice area (3D-AROA) and the slope of tricuspid annular plane systolic excursion vs. systolic pulmonary artery pressure (TAPSE/SPAP) and to validate its prognostic significance. Methods and results Sixty-four patients with severe functional TR (52% torrential) underwent 3D echocardiography and exercise–stress echocardiography. As an estimate of regurgitation severity, 3D-AROA was measured with the customized software package. As an index of right ventricular (RV) contractile reserve, the TAPSE/SPAP slope was calculated by plotting the relationship between TAPSE and SPAP during exercise test. Haemodynamic parameters were obtained by right heart catheterization (RHC). Based on receiver operating characteristics curves, optimal cut-off values of 3D-AROA and TAPSE/SPAP slope to identify all-cause mortality were 161 mm2 and 0.046 mm/mmHg, respectively. During a median follow-up of 559 days, 20 patients (31%) died. After correcting for potential confounders, 3DAROA≥ 161 mm2 (HR 4.37; 95% CI 1.34–14.07; P = 0.015) and TAPSE/SPAP slope≤0.046 mm/mmHg (HR 4.76; 95% CI 1.46–15.53; P = 0.009) were echocardiographic parameters independently associated with all-cause mortality. The cumulative survival rate was lower in patients with 3D-AROA≥161 mm2 and TAPSE/SPAP slope≤0.046 mm/mmHg compared with their counterparts (both P&lt;0.05). RHC confirmed higher right atrial pressure (P&lt;0.001) and lower cardiac index (P = 0.004) in patients with both 3D-AROA≥161 mm2 and TAPSE/SPAP slope ≤0.046 mm/mmHg. Conclusion Large AROA and reduced RV contractile reserve during exercise are independently associated with poor prognosis. The new grading scheme of severe TR was validated by haemodynamics and may improve risk stratification. 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Methods and results Sixty-four patients with severe functional TR (52% torrential) underwent 3D echocardiography and exercise–stress echocardiography. As an estimate of regurgitation severity, 3D-AROA was measured with the customized software package. As an index of right ventricular (RV) contractile reserve, the TAPSE/SPAP slope was calculated by plotting the relationship between TAPSE and SPAP during exercise test. Haemodynamic parameters were obtained by right heart catheterization (RHC). Based on receiver operating characteristics curves, optimal cut-off values of 3D-AROA and TAPSE/SPAP slope to identify all-cause mortality were 161 mm2 and 0.046 mm/mmHg, respectively. During a median follow-up of 559 days, 20 patients (31%) died. After correcting for potential confounders, 3DAROA≥ 161 mm2 (HR 4.37; 95% CI 1.34–14.07; P = 0.015) and TAPSE/SPAP slope≤0.046 mm/mmHg (HR 4.76; 95% CI 1.46–15.53; P = 0.009) were echocardiographic parameters independently associated with all-cause mortality. The cumulative survival rate was lower in patients with 3D-AROA≥161 mm2 and TAPSE/SPAP slope≤0.046 mm/mmHg compared with their counterparts (both P&lt;0.05). RHC confirmed higher right atrial pressure (P&lt;0.001) and lower cardiac index (P = 0.004) in patients with both 3D-AROA≥161 mm2 and TAPSE/SPAP slope ≤0.046 mm/mmHg. Conclusion Large AROA and reduced RV contractile reserve during exercise are independently associated with poor prognosis. The new grading scheme of severe TR was validated by haemodynamics and may improve risk stratification. Graphical Abstract Graphical Abstract Kaplan–Meier curves for survival in severe tricuspid regurgitation according to a proposed risk stratification system using 3D-AROA and TAPSE/SPAP slope.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35134908</pmid><doi>10.1093/ehjci/jeac004</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6587-9584</orcidid></addata></record>
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title Role of anatomical regurgitant orifice area and right ventricular contractile reserve in severe tricuspid regurgitation
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