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The International Journal of... Mar 2024Evaluating right ventricular (RV) function remains a challenge. Recently, novel echocardiographic assessment of RV myocardial work (RVMW) by non-invasive pressure-strain...
Evaluating right ventricular (RV) function remains a challenge. Recently, novel echocardiographic assessment of RV myocardial work (RVMW) by non-invasive pressure-strain loops was proposed. This enables evaluation of right ventriculoarterial coupling and quantifies RV dyssynchrony and post-systolic shortening. We aimed to assess RVMW in patients with different etiologies of RV dysfunction and healthy controls. We investigated healthy controls (n=17), patients with severe functional tricuspid regurgitation (FTR; n=22), and patients with precapillary pulmonary hypertension (PCPH; n=20). Echocardiography and right heart catheterization were performed to assess 1) RV global constructive work (RVGCW; work needed for systolic myocardial shortening and isovolumic relaxation), 2) RV global wasted work (RVGWW; myocardial shortening following pulmonic valve closure), and 3) RV global work efficiency (RVGWE; describes the relation between RV constructive and wasted work). RVGCW correlated with invasive RV stroke work index (r=0.66, P<0.001) and increased in tandem with higher afterload, i.e., was low in healthy controls (454±73 mmHg%), moderate in patients with FTR (687±203 mmHg%), and highest among patients with PCPH (881±255 mmHg%). RVGWE was lower and RVGWW was higher in patients with FTR (86±8% and 91 mmHg% [53-140]) or PCPH (86±10% and 110 mmHg% [66-159]) as compared with healthy controls (96±3% and 10 mmHg%). RVMW by echocardiography provides a promising index of RV function to discriminate between patients with RV volume or pressure overload. The prognostic value of this measure needs to be settled in future studies.
Topics: Humans; Ventricular Dysfunction, Right; Predictive Value of Tests; Echocardiography; Systole; Tricuspid Valve Insufficiency; Ventricular Function, Right; Stroke Volume
PubMed: 38305942
DOI: 10.1007/s10554-023-03038-y -
International Journal of Cardiology Feb 2024Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a...
BACKGROUND AND AIMS
Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a geographically defined area and its outcome, in particular overall survival and hospitalization, considering different clinical contexts.
METHODS
We retrospectively analyzed consecutive outpatients referred between 2006 and 2013 for echocardiography and clinical evaluation. Patients with at least moderate TR were included and five different clinical settings were defined: concomitant significant left-sided valvular heart disease (LVHD-TR), heart failure (HF-TR), previous open-heart valvular surgery (postop-TR), pulmonary hypertension (PHTN-TR) and isolated TR (isolated-TR). Primary endpoint was a composite outcome of all-cause mortality or first hospitalization for HF.
RESULTS
Of 6797 consecutive patients with a clinical visit and echocardiograms performed in routine practice in a geographically defined community, moderate or severe TR was found in 4.8% of patients (327) . During median follow-up of 6.1 years, TR severity was a determinant of event-free survival. Analyzed for each clinical subset, eight-year event-free survival was 87 ± 7% for postop-TR subgroup, 75 ± 7% for isolated-TR, 67 ± 6% for PHTN-TR, 58 ± 6% for LHVD -TR and 52 ± 11% for HF-TR.
CONCLUSION
Moderate or more TR is a notable finding in the community and has impact on event-free survival in all clinical settings, with the worst outcomes when associated with relevant left-sided valvular heart disease and HF.
Topics: Humans; Tricuspid Valve Insufficiency; Retrospective Studies; Outpatients; Heart Failure; Echocardiography; Treatment Outcome
PubMed: 37844668
DOI: 10.1016/j.ijcard.2023.131443 -
The American Journal of Cardiology Jul 2024Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with pure severe aortic regurgitation (PSAR) who are contraindicated...
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with pure severe aortic regurgitation (PSAR) who are contraindicated for surgery or have a high surgical risk. However, the therapeutic efficacy and safety of TAVR in low Society of Thoracic Surgeons (STS) score risk patients remain to be clarified. This study aimed to explore the feasibility of TAVR treatment in different STS-risk patients and to compare the adverse events between the groups. In this study, patients with PSAR who underwent TAVR at Zhongshan Hospital, Fudan University, China, during the inclusion period were included and categorized into 3 groups based on STS scores. The baseline data, imaging results, and follow-up data of the patients were documented. Therefore, of 75 TAVR patients, 38 (50.7%) were categorized as low risk (STS <4), and 37 (49.3%) patients were categorized as intermediate and high risk (STS ≥4). Compared with patients at intermediate and high risk, those in the low-risk group were younger, had a lower body mass index, had a lower prevalence of hypertension, chronic obstructive pulmonary disease, and previous percutaneous coronary intervention, and had better cardiac function (p all <0.05). In the hospital and at the 1-month follow-up, the degree of aortic regurgitation and cardiac function were significantly improved. No significant difference was found between the 2 groups in the hospital or during the 30-day follow-up. In conclusion, TAVR for PSAR in low-STS-risk patients is safe and efficient during 30 days of follow-up compared with intermediate- and high-STS-risk groups. TAVR for PSAR should not be limited to inoperable or STS-defined high-risk patients. Long-term follow-up is needed for further investigation.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve Insufficiency; Male; Female; Aged; Treatment Outcome; Severity of Illness Index; Risk Assessment; Retrospective Studies; China; Risk Factors; Follow-Up Studies; Aged, 80 and over; Time Factors
PubMed: 38703883
DOI: 10.1016/j.amjcard.2024.04.056 -
European Journal of Heart Failure Apr 2024While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation...
AIMS
While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)-related right- heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI.
METHODS AND RESULTS
Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76-83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2-year mortality on Cox regression analyses with Youden index-derived cut-offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre-interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left-sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right-sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right-sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates.
CONCLUSION
In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right-sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre-interventional reduction of right-sided congestion can improve outcomes after TTVI should be established in dedicated studies.
Topics: Humans; Female; Male; Tricuspid Valve Insufficiency; Aged; Registries; Cardiac Catheterization; Aged, 80 and over; Pulmonary Wedge Pressure; Heart Failure; Severity of Illness Index; Prognosis; Heart Valve Prosthesis Implantation; Tricuspid Valve; Treatment Outcome
PubMed: 38571456
DOI: 10.1002/ejhf.3235 -
Clinical Research in Cardiology :... Aug 2023A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening...
AIMS
A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening tricuspid regurgitation leading to systemic venous congestion, reflected by an increase in inferior vena cava (IVC) diameter. We hypothesized that venous congestion rather than pulmonary hypertension would be more strongly associated with prognosis.
METHODS AND RESULTS
895 patients with chronic heart failure (CHF) (median (25th and 75th centile) age 75 (67-81) years, 69% men, LVEF 44 (34-55)% and NT-proBNP 1133 (423-2465) pg/ml) were enrolled. Compared to patients with normal IVC (< 21 mm) and TRV (≤ 2.8 m/s; n = 504, 56%), those with high TRV but normal IVC (n = 85, 9%) were older, more likely to be women and to have LVEF ≥ 50%, whilst those with dilated IVC but normal TRV (n = 142, 16%) had more signs of congestion and higher NT-proBNP. Patients (n = 164, 19%) with both dilated IVC and high TRV had the most signs of congestion and the highest NT-proBNP. During follow-up of 860 (435-1121) days, 239 patients died. Compared to those with both normal IVC and TRV (reference), patients with high TRV but normal IVC did not have a significantly increased mortality (HR: 1.41; CI: 0.87-2.29; P = 0.16). Risk was higher for patients with a dilated IVC but normal TRV (HR: 2.51; CI: 1.80-3.51; P < 0.001) or both a dilated IVC and elevated TRV (HR: 3.27; CI: 2.40-4.46; P < 0.001).
CONCLUSION
Amongst ambulatory patients with CHF, a dilated IVC is more closely associated with an adverse prognosis than an elevated TRV.
Topics: Male; Humans; Female; Aged; Tricuspid Valve Insufficiency; Hypertension, Pulmonary; Vena Cava, Inferior; Hyperemia; Prognosis; Heart Failure
PubMed: 36894788
DOI: 10.1007/s00392-023-02178-4 -
Alternative Therapies in Health and... Sep 2023To compare the clinical efficacy and safety of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography in the treatment of bile duct...
Comparison of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography in the Treatment of Bile Duct Stones and Analysis of Risk Factors for Postoperative Acute Pancreatitis.
OBJECTIVE
To compare the clinical efficacy and safety of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography in the treatment of bile duct stones, and to analyze the related factors influencing postoperative acute pancreatitis.
METHODS
From March 2017 to June 2021, we recruited patients with bile duct stones to our study: 175 patients undergoing endoscopic retrograde cholangiopancreato-graphy and 147 patients undergoing laparoscopic common bile duct exploration. The operative time, intraoperative blood loss, conversion to laparotomy, postoperative exhaust time, hospitalization time, liver function before and after the operation, and the incidence of adverse events were compared. Logistic regression analysis was used to analyze the related factors influencing postoperative acute pancreatitis.
RESULTS
All patients were operated on successfully, with no conversion to laparotomy. Operative time, postoperative exhaust time, and hospitalization time were shorter, intraoperative blood loss was lower, and aspartate aminotransferase and alanine aminotransferase were higher in the endoscopic retrograde cholangiopancreato-graphy group compared with the laparoscopic common bile duct exploration group (P < .05). The endoscopic retrograde cholangiopancreatography group had a higher incidence of adverse events than the laparoscopic common bile duct exploration group (P < .05). After logistic regression analysis, white blood cell concentration, operative time, intraoperative blood loss, previous history of pancreatic disease, and endoscopic retrograde cholangiopancreatography operation all independently influenced the occurrence of acute pancreatitis.
CONCLUSION
Laparoscopic common bile duct exploration is our first choice for patients with bile duct stones who have no history of abdominal surgery, cardiac or pulmonary valve insufficiency, bile duct stenosis, and poor duodenal papilla function, as it can reduce the occurrence of postoperative complications and shorten rehabilitation. Further investigation of the factors that independently caused postoperative acute pancreatitis after stone removal is warranted.
PubMed: 37347694
DOI: No ID Found -
CJC Pediatric and Congenital Heart... Aug 2023
PubMed: 37969859
DOI: 10.1016/j.cjcpc.2023.03.003 -
Journal of the American Heart... Apr 2024The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation....
Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation.
BACKGROUND
The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population.
METHODS AND RESULTS
We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome.
CONCLUSIONS
Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
Topics: Humans; Tricuspid Valve Insufficiency; Prognosis; Retrospective Studies; Atrial Pressure; Echocardiography; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 38609840
DOI: 10.1161/JAHA.123.033196 -
Revista Portuguesa de Cardiologia :... Nov 2023A 57-year-old male with previously known severe primary mitral regurgitation was admitted to the intensive care unit (ICU) due to massive venous thromboembolism,...
A 57-year-old male with previously known severe primary mitral regurgitation was admitted to the intensive care unit (ICU) due to massive venous thromboembolism, associated with right ventricular dysfunction and two large mobile right atrial thrombi. Due to deterioration in his clinical condition despite standard treatment with unfractionated heparin, it was decided to use an ultra-slow low-dose thrombolysis protocol, which consisted of a 24-hour infusion of 24 mg of alteplase at a rate of 1 mg per hour, without initial bolus. The treatment was continued for 48 consecutive hours, with clinical improvement and resolution of the intracardiac thrombi and no complications. One month after ICU admission, successful mitral valve repair surgery was conducted. This case demonstrates that ultra-slow low-dose thrombolysis is a valid bailout treatment option in patients with large intracardiac thrombi refractory to the standard approach.
Topics: Male; Humans; Middle Aged; Heparin; Heart Diseases; Thrombolytic Therapy; Thrombosis; Thromboembolism; Pulmonary Embolism
PubMed: 37156417
DOI: 10.1016/j.repc.2019.09.023 -
Journal of Biomechanics Jun 2024To better understand the impact of valvular heart disease (VHD) on the hemodynamics of the circulatory system, investigations can be carried out using a model of the...
To better understand the impact of valvular heart disease (VHD) on the hemodynamics of the circulatory system, investigations can be carried out using a model of the cardiovascular system. In this study, a previously developed hybrid (hydro-numerical) simulator of the cardiovascular system (HCS) was adapted and used. In our HCS Björk-Shiley mechanical heart valves were used, playing the role of mitral and aortic ones. In order to simulate aortic stenosis (AS) and mitral regurgitation (MR), special mechanical devices have been developed and integrated with the HCS. The simulation results proved that the system works correctly. Namely, in the case of AS - the mean pulmonary arterial pressure was increased due to increased preload of the left ventricle and the decrease in right ventricular preload was caused by a decrease in systemic arterial pressure. The severity of AS was performed based on the transaortic pressure gradient as well as using the Gorlin and Aaslid equations. In the case of severe AS, when the mean gradient was above 40 mmHg, the aortic valve orifice area was 0.5 cm, which is in line with ACC/AHA guidelines. For the case of MR - with increasing severity of MR, there was a decrease in the left ventricular pressure and an increase in left atrial pressure. Using mechanical heart valves to simulate VHD by the HCS can be a valuable tool for biomedical research, providing a safe and controlled environment to study and understand the pathophysiology of VHD.
Topics: Humans; Models, Cardiovascular; Computer Simulation; Hemodynamics; Mitral Valve Insufficiency; Aortic Valve Stenosis; Heart Valve Diseases; Heart Valve Prosthesis; Mitral Valve
PubMed: 38805856
DOI: 10.1016/j.jbiomech.2024.112173