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Hinojar R, Rodriguez Palomares J, Eiros R, Barreiro M, Ramos N, Rodriguez Diego S, Gutiérrez L, Calero MJ, Muriel A, González Gómez A, García Martin A, Fernández-Golfín C, Zamorano JL. Unlocking prognostic insights in severe tricuspid regurgitation: impact of right ventricular volumes and function by cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 2025; 26:1007-1017. [PMID: 40120094 DOI: 10.1093/ehjci/jeaf097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 02/06/2025] [Accepted: 03/13/2025] [Indexed: 03/25/2025] Open
Abstract
AIMS To describe prognostic cut-off values of right ventricular (RV) size and function by cardiac magnetic resonance (CMR) in a multicentre cohort of patients with severe tricuspid regurgitation (TR). METHODS AND RESULTS The study enrolled patients with at least severe TR (severe, massive, and torrential) assessed by 2D echocardiography undergoing a contemporary CMR study. The primary endpoint was defined as combined endpoint of all-cause mortality or hospitalization for heart failure (HF) events, and the secondary endpoint was defined as cardiovascular mortality. Three hundred fourteen patients with severe TR were included in this study (70 ± 11 years, 67% female, 79% NYHA I or II). During a median follow-up of 35 months (interquartile range: 12-60), 39% of the patients experienced the combined endpoint. After adjusting for clinical and imaging variables, RV end-diastolic volume (RV-EDV) and RV ejection fraction (RVEF) were independently associated with all-cause mortality and HF (adj HR for RV-EDV: 1.015 [1.012-1.019], P < 0.001; adj HR for RVEF: 0.957 [0.938-0.976], P < 0.001). Thresholds of highest risk were defined by RV-EDV > 150 mL/m² and RVEF < 50%, while intermediate risk was defined by RV-EDV between 100 and 150 mL/m² and RVEF between 50% and 60%. Compared with low-risk groups, adjusted threshold for high-risk (adj HR for RV-EDV > 150 mL/m2: 5.42 [3.20-9.16] and for RVEF < 50%: 2.12 [1.21-3.71]) and intermediate-risk (adj HR for RV-EDV 100-150 mL/m2: 1.72 [1.11-2.64] and for RVEF 50-60%: 1.59 [1.04-2.43]) was significantly associated with impaired outcomes. CONCLUSION Thresholds of RV volume and function by CMR stratifying low-intermediate and high-risk of cardiovascular events are defined in a multicentre cohort of patients. Compared with low-risk group, high- and, to a lower extent, intermediate-risk groups are independently associated to HF and all-cause mortality.
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Affiliation(s)
- Rocio Hinojar
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | | | - Rocio Eiros
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Cardiology Department, University Hospital of Salamanca, Salamanca, Spain
| | - Manuel Barreiro
- Cardiology Department, Alvaro Cunqueiro Hospital, Vigo, Spain
| | - Noemi Ramos
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sara Rodriguez Diego
- Cardiology Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Laura Gutiérrez
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria José Calero
- Cardiology Department, Infanta Elena University Hospital, Madrid, Spain
| | - Alfonso Muriel
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Biostatistic Unit, University Hospital Ramón y Cajal, Spain
- CIBERESP, Instituto de Salud Carlos III (ISCIII), Spain
- Alcalá University, Madrid, Spain
| | - Ariana González Gómez
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Ana García Martin
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Covadonga Fernández-Golfín
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
- Alcalá University, Madrid, Spain
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Lv J, Lu Q, Xu H, Wu Y. Cardio-Renal-Hepatic Interactions Following Tricuspid Valve Transcatheter Edge-to-Edge Repair. J Am Coll Cardiol 2025; 85:1583-1584. [PMID: 40240098 DOI: 10.1016/j.jacc.2024.09.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 09/28/2024] [Indexed: 04/18/2025]
Affiliation(s)
- Junxing Lv
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qianhong Lu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Angellotti D, Franzone A, Brugger N, Reineke D, Esposito G, Praz F. Optimizing the management of tricuspid regurgitation: an update on current treatment strategies and perspectives. Expert Rev Cardiovasc Ther 2025; 23:131-139. [PMID: 40177965 DOI: 10.1080/14779072.2025.2488869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 04/01/2025] [Indexed: 04/05/2025]
Abstract
INTRODUCTION Tricuspid regurgitation (TR) is a prevalent condition and is independently associated with high morbidity and mortality rates. Despite its prognostic impact, TR remains undertreated, with patients often referred at late stages when medical therapy is ineffective and surgical intervention high risk. Emerging transcatheter therapies offer a promising alternative for safer and effective management of this elderly patient population with numerous comorbidities. AREAS COVERED This review highlights recent advances in treatment strategies and future directions for addressing significant TR. The literature search was conducted across the PubMed, Embase, Scopus, and Google Scholar databases. A structured search strategy was developed using 'tricuspid regurgitation' and 'management' or 'treatment' or 'therapy' and 'surgery' or 'tricuspid valve repair' or 'tricuspid valve replacement' or 'transcatheter tricuspid intervention' as MeSH terms and keywords. Selected articles from 2017 to present were critically analyzed for strengths, limitations, and gaps in evidence. EXPERT OPINION Enhancing disease awareness, the involvement of multidisciplinary Heart Team and intervening earlier are critical priorities for TR therapies to prevent treatment futility. Improved device designs, more performant imaging techniques, and dedicated research endpoints will help optimizing the management of TR.
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Affiliation(s)
- Domenico Angellotti
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Reineke
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Hausleiter J, Stolz L, Lurz P, Rudolph V, Hahn R, Estévez-Loureiro R, Davidson C, Zahr F, Kodali S, Makkar R, Cheung A, Lopes RD, Maisano F, Fam N, Latib A, Windecker S, Praz F. Transcatheter Tricuspid Valve Replacement. J Am Coll Cardiol 2025; 85:265-291. [PMID: 39580719 DOI: 10.1016/j.jacc.2024.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 10/11/2024] [Accepted: 10/11/2024] [Indexed: 11/26/2024]
Abstract
Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising intervention for the treatment of severe tricuspid regurgitation with complex valve morphology. This consensus document provides a comprehensive overview of the current state of orthotopic TTVR, focusing on patient selection, procedural details, and follow-up care. Clinical outcomes from initial studies and compassionate use cases are discussed, highlighting the effectiveness of TTVR in reducing tricuspid regurgitation, inducing reverse right ventricular remodeling, and enhancing patients' quality of life. This review paper also addresses potential complications and challenges associated with TTVR, such as new-onset conduction disturbances, bleeding complications, and afterload mismatch, and provides expert recommendations for the periprocedural management, anticoagulation strategies, and long-term follow-up. With the commercial approval of the first TTVR system in the United States and Europe, it intends to serve as a reference for clinicians and researchers involved in the evolving field of transcatheter tricuspid valve interventions.
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Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. https://twitter.com/stolz_l
| | - Philipp Lurz
- Cardiology Center, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Rebecca Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Charles Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Anson Cheung
- Division of Cardiothoracic Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA; Brazilian Clinical Research Institute (BCRI), São Paulo, Brazil
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Neil Fam
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephan Windecker
- Department of Cardiology Bern University Hospital, Inselspital, University of Berne, Berne, Switzerland
| | - Fabien Praz
- Department of Cardiology Bern University Hospital, Inselspital, University of Berne, Berne, Switzerland. https://twitter.com/FabienPraz
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Metra M, Adamo M, Butler J. Improving Outcome in Patients With Tricuspid Regurgitation: Look At the Kidneys and the Liver! J Am Coll Cardiol 2024; 84:2457-2459. [PMID: 39663006 DOI: 10.1016/j.jacc.2024.09.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 09/25/2024] [Accepted: 09/30/2024] [Indexed: 12/13/2024]
Affiliation(s)
- Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
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