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Medical Sciences (Basel, Switzerland) Jun 2022Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of... (Review)
Review
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
Topics: Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Rheumatic Heart Disease; Tricuspid Valve Insufficiency; Young Adult
PubMed: 35736352
DOI: 10.3390/medsci10020032 -
JACC. Cardiovascular Imaging Mar 2019Assessing the severity of tricuspid regurgitation remains a challenging task, and although echocardiography is the test of choice, significant limitations of the current... (Review)
Review
Assessing the severity of tricuspid regurgitation remains a challenging task, and although echocardiography is the test of choice, significant limitations of the current recommendations exist. Newer methods have been used in current trials of transcatheter devices and may improve our understanding of the disease process. Cardiac magnetic resonance imaging and computed tomography angiography may play significant roles as adjunctive imaging modalities. This paper reviews the imaging modalities currently used to quantify tricuspid regurgitation severity.
Topics: Computed Tomography Angiography; Coronary Angiography; Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Echocardiography, Three-Dimensional; Hemodynamics; Humans; Magnetic Resonance Imaging; Predictive Value of Tests; Severity of Illness Index; Tomography, X-Ray Computed; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846122
DOI: 10.1016/j.jcmg.2018.07.033 -
JACC. Cardiovascular Imaging Mar 2019An appreciation of the complex and variable anatomy of the tricuspid valve is essential to unraveling the pathophysiology of tricuspid regurgitation. A greater... (Review)
Review
An appreciation of the complex and variable anatomy of the tricuspid valve is essential to unraveling the pathophysiology of tricuspid regurgitation. A greater appreciation of normal and abnormal anatomy is important as new methods of treating the tricuspid regurgitation are developed. This review of tricuspid valve and right heart anatomy is followed by a discussion of the possible pathophysiology of secondary (functional) tricuspid regurgitation.
Topics: Hemodynamics; Humans; Risk Factors; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Function, Right
PubMed: 30846121
DOI: 10.1016/j.jcmg.2018.07.032 -
JACC. Cardiovascular Imaging Mar 2019Tricuspid regurgitation (TR) is classified according to different morphologic types based on the underlying mechanisms: primary, secondary, and isolated TR. Primary TR... (Review)
Review
Tricuspid regurgitation (TR) is classified according to different morphologic types based on the underlying mechanisms: primary, secondary, and isolated TR. Primary TR is caused by an anatomical abnormality of the tricuspid valve apparatus. Secondary TR is caused by dilation of the tricuspid valve annulus, related to right ventricular (RV), or right atrial remodeling and increased RV pressures (often secondary to left-sided heart disease). Isolated TR can exist in patients without increased RV pressures and is frequently associated with atrial fibrillation. Two-dimensional echocardiography plays a pivotal role in the assessment of the etiology and severity of TR. Views from 3-dimensional techniques have significantly increased the understanding of the pathophysiology of each morphologic type of TR (leaflet damage, annular dilation, and distinct patterns of right-heart remodeling). The following review will describe the etiology, anatomical and functional characteristics, and outcomes of each morphologic type of TR, and furthermore addresses challenging pitfalls in the referral for tricuspid valve intervention.
Topics: Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Hemodynamics; Humans; Predictive Value of Tests; Prognosis; Severity of Illness Index; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846123
DOI: 10.1016/j.jcmg.2018.09.027 -
Reviews in Cardiovascular Medicine Dec 2021Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than... (Review)
Review
Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men. This review summarizes data concerning etiology, epidemiology, pathophysiology and management strategies of TR. The tricuspid valve (TV) has a broad anatomical variability. Classically, TR has been distinguished as primary and secondary or functional TR (FTR), with the latter being the most prevalent. FTR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus and base of the right ventricle, with pathological TV coaptation. Thus two main types of FTR can be identified: pulmonary hypertension-FTR and idiopathic-FTR, depending on which factor, ventricular or atrial respectively, is the of the disease. Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target. The treatment of TR in patients undergoing left-sided cardiac surgery is well established. Isolated surgical repair of TR is instead rarely performed because patients are often deemed inoperable due to prohibitive risk. Besides, perioperative mortality remains higher than for any other valve. Several transcatheter TV replacement and repair systems, the latter mostly borrowed from percutaneous treatment systems of mitral regurgitation or from TV repair surgical techniques, have shown efficacy and safety when used on the TV. These could provide an effective treatment option for patients not eligible for surgery.
Topics: Aged; Female; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve Insufficiency; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Remodeling
PubMed: 34957757
DOI: 10.31083/j.rcm2204122 -
Journal of the American College of... Oct 2023Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history... (Review)
Review
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
Topics: Humans; Tricuspid Valve Insufficiency; Tricuspid Valve; Heart Valve Prosthesis Implantation; Cardiac Catheterization; Treatment Outcome; Severity of Illness Index
PubMed: 37804294
DOI: 10.1016/j.jacc.2023.08.008 -
JACC. Cardiovascular Imaging Mar 2019Tricuspid regurgitation (TR) is an independent predictor of death. Lately, emerging technologies for the treatment of TR have increased the interest of physicians. Due... (Review)
Review
Tricuspid regurgitation (TR) is an independent predictor of death. Lately, emerging technologies for the treatment of TR have increased the interest of physicians. Due to the complex 3-dimensional (3D) geometry of the tricuspid valve (TV) and its anterior position in the mediastinum, conventional 2D echocardiography is unsuitable to study the anatomy and pathophysiologic mechanisms of the regurgitant TV. 3D echocardiography has emerged as a very cost-effective imaging modality with which to: 1) visualize the TV anatomy; 2) define the mechanism of TR; 3) measure the size and geometry of the tricuspid annulus; 4) analyze the anatomic relationships between TV apparatus and surrounding cardiac structures; 5) assess volumes and function of the right atrium and ventricle; and 6) plan surgical repair or guide and monitor transcatheter interventional procedures.
Topics: Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Hemodynamics; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846124
DOI: 10.1016/j.jcmg.2018.10.035 -
JACC. Cardiovascular Imaging Apr 2019With the expanding use of cardiac implantable electronic device (CIEDs) in an ever-aging population, the looming problem of CIED-associated interference with the... (Review)
Review
With the expanding use of cardiac implantable electronic device (CIEDs) in an ever-aging population, the looming problem of CIED-associated interference with the tricuspid valve is significant. The first pacemaker was implanted in 1958 for severe symptomatic bradycardia. The concept of a device to avert sudden cardiac death (i.e., the defibrillator) was first published in 1970 by Mirowski and Mower. The first reports of CIED-mediated tricuspid valve apparatus interference surfaced in the late 1900s, but it was not until recently that concentrated efforts have been made to better define the scope of CIED-mediated interference with the tricuspid valve apparatus. Because stopping implantation of these devices is not an option, better understanding of their mechanical complications could potentially lead to improvements in device design or epicardial device implantation, as an alternative, in select patients. This review covers existing evidence for CIED-mediated tricuspid regurgitation, discusses potential mechanisms of CIED-mediated interference of the tricuspid valve apparatus, provides an overview of how to diagnose CIED-mediated interference on echocardiography, and discusses management strategies for patients who have CIED-mediated severe tricuspid regurgitation.
Topics: Cardiac Catheterization; Defibrillators, Implantable; Device Removal; Diuretics; Echocardiography; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Pacemaker, Artificial; Prosthesis Design; Risk Factors; Severity of Illness Index; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30947905
DOI: 10.1016/j.jcmg.2018.09.028 -
JACC. Cardiovascular Interventions Mar 2022The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter...
OBJECTIVES
The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk.
BACKGROUND
Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life.
METHODS
In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days.
RESULTS
Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001).
CONCLUSIONS
Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
Topics: Aged; Cardiac Catheterization; Female; Heart Valve Prosthesis Implantation; Humans; Male; Prospective Studies; Quality of Life; Severity of Illness Index; Time Factors; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 35272771
DOI: 10.1016/j.jcin.2022.01.016 -
JACC. Cardiovascular Imaging Mar 2019
Topics: Hemodynamics; Humans; Predictive Value of Tests; Prognosis; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846131
DOI: 10.1016/j.jcmg.2019.01.010