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Wintrich J, Bismpos D, Teusch A, Pavlicek V, Fischer P, Mahfoud F, Böhm M, Ukena C. Severity of tricuspid regurgitation predicts risk of recurrence of atrial fibrillation after pulmonary vein isolation. ESC Heart Fail 2025; 12:1905-1915. [PMID: 40139818 PMCID: PMC12055437 DOI: 10.1002/ehf2.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 11/02/2024] [Accepted: 12/10/2024] [Indexed: 03/29/2025] Open
Abstract
AIMS Tricuspid regurgitation (TR) results in right atrial remodelling, thus promoting the formation of a substrate for atrial fibrillation (AF). In turn, AF may cause TR by annulus dilatation. We investigated whether the presence of TR affects the efficacy of pulmonary vein isolation (PVI) for AF. METHODS AND RESULTS In patients undergoing PVI, we compared the severity of TR before and 6 months after the procedure. Moderate to severe TR was defined as advanced. Moreover, we investigated whether the severity of TR, at baseline and 6 months after PVI, predicted the recurrence of AF. Out of 320 patients, advanced TR at baseline was documented in 13.1%. Six months after PVI, the proportion of patients with advanced TR (13.1% to 7.2%; P < 0.001) decreased significantly. Compared with patients with post-interventional improvement of advanced TR, right atrial (RA) dilatation at baseline was more pronounced in patients without TR improvement (RA area 20.2 ± 4.4 vs. 26.6 ± 8.3 cm). The presence of advanced TR, particularly without improvement during the follow-up, increased the risk of AF recurrences compared with patients without advanced TR. Even after propensity-score matching, TR at baseline remained an independent risk predictor regarding recurrent AF [hazard ratio 2.2 (95% confidence interval, 1.1-4.9); P = 0.045]. Advanced MR was not associated with increased risk of AF. CONCLUSIONS In AF patients undergoing PVI, the presence of advanced TR, particularly without improvement 6 months after the procedure, was associated with an increased risk of AF recurrences.
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Affiliation(s)
- Jan Wintrich
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
- Department of Internal Medicine II, Cardiology and Angiology, Marien Hospital HerneRuhr University BochumBochumGermany
| | - Dimitrios Bismpos
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
- Department of Internal Medicine II, Cardiology and Angiology, Marien Hospital HerneRuhr University BochumBochumGermany
| | - Anika Teusch
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
| | - Valerie Pavlicek
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
| | - Patrick Fischer
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
- Department of CardiologyUniversity Heart Center, University Hospital BaselBaselSwitzerland
- Cardiovascular Research Institute Basel (CRIB), University Heart CenterUniversity Hospital BaselBaselSwitzerland
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineUniversity Hospital, Saarland UniversityHomburgGermany
- Department of Internal Medicine II, Cardiology and Angiology, Marien Hospital HerneRuhr University BochumBochumGermany
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Loutati R, Katz A, Segev A, Kuperstein R, Sabbag A, Maor E. A decade of follow-up: atrial fibrillation, pulmonary pressure, and the progression of tricuspid regurgitation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2025; 11:312-322. [PMID: 39217100 DOI: 10.1093/ehjqcco/qcae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/16/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Long-term data on atrial fibrillation (AF) impact on tricuspid regurgitation (TR) progression and its relation to pulmonary pressure are scant. We investigated this association in a study spanning over a decade. METHODS AND RESULTS Adults with echocardiographic evaluation before 2014, free of significant TR, were included. Patients were dichotomized by baseline AF, followed by stratification according to systolic pulmonary artery pressure (sPAP). The development of new significant TR and its impact on mortality were studied. Study population included 21 502 patients (median age 65, 40% female), 13% had baseline AF. During a median follow-up of 12 years, 11% developed significant TR. Compared with patients free of AF, patients with baseline AF were 3.5 and 1.3 times more likely to develop significant TR in univariate and multivariate models, respectively (95% CI 3.27-3.91, 1.18-1.44, P < 0.001 for both). The risk of TR progression was higher in patients with permanent AF and those treated with rate control strategy (hazard ratio 1.95 and 2.01, respectively; P < 0.001 for both). The association of AF with TR progression was sPAP-related, being more pronounced among patients with normal sPAP than among those with elevated sPAP (HR 1.5 vs. 1.18; P for interaction <0.001). TR progression was independently linked to a two-fold higher mortality risk, consistent regardless of baseline AF (P < 0.001). CONCLUSION AF is an independent predictor of TR progression, especially in patients with normal sPAP. Subsequent research on strategies to prevent TR progression in this patient population is warranted.
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Affiliation(s)
- Ranel Loutati
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Katz
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Sabbag
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- The Olga and Lev Leviev Heart Center, Chaim Sheba Medical Center Hospital, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Segan L, Prabhu S, Nanayakkara S, Taylor A, Hare J, Crowley R, William J, Cho K, Lim M, Koh Y, Das S, Chieng D, Sugumar H, Voskoboinik A, Ling LH, Costello B, Kaye DM, McLellan A, Lee G, Morton JB, Kalman JM, Kistler PM. Impact of Mitral Regurgitation on Outcomes of Catheter Ablation for AF With Left Ventricular Systolic Dysfunction. JACC Clin Electrophysiol 2025:S2405-500X(25)00252-X. [PMID: 40278816 DOI: 10.1016/j.jacep.2025.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/28/2025] [Accepted: 04/04/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND Atrial fibrillation (AF) and left ventricular (LV) systolic dysfunction (LVSD) may be associated with function mitral and tricuspid regurgitation (FMR/FTR). Prior studies have largely assessed impact of MR on AF ablation outcomes in the presence of preserved LV ejection fraction. OBJECTIVES This study sought to determine the impact of FMR on the outcomes of catheter ablation (CA) in patients with AF and LVSD. METHODS We examined baseline clinical characteristics, CA outcomes, and change in echocardiographic parameters (FMR and FTR severity, LV and left atrial [LA] dimensions, LVEF) at baseline and 12 months in individuals with AF and LVSD with at least mild FMR undergoing CA. Patients with primary mitral valve disease were excluded. RESULTS 235 patients (age 62.8 years,16.2% female, NYHA functional class III (Q1-Q3: II-III)) underwent CA and were categorized by FMR severity at baseline (mild n = 117; moderate/severe n = 118). Baseline characteristics were comparable irrespective of degree of FMR, other than lower LVEF (LVEF 29% [Q1-Q3: 22.8%-35.0%] vs 35% [Q1-Q3: 30.0%-41.0%]; P < 0.001) and increased tricuspid regurgitation in moderate/severe MR (22%) vs mild MR (8%, P < 0.001). LA size did not differ significantly across FMR groups (P = 0.233). At 12 months following CA, recurrent atrial arrhythmia occurred in 101 of 235 (43.0%) including 42.7% in mild vs 43.2% in moderate-to-severe MR (P = 0.940). The severity of FMR did not influence arrhythmia recurrence (OR: 1.15; 95% CI: 0.54-1.86; P = 0.601) nor LV recovery (OR: 1.07; 95% CI: 0.67-1.25; P = 0.153). After CA, 89% of those with significant FMR and 85% with significant FTR exhibited ≥1 grade reduction at 12 months. Change in LV dimensions was associated with MR responders (OR: 0.93; 95% CI: 0.87-0.99; P = 0.022) with a greater reduction in LV size at 12 months in MR improvement (-5.0 (Q1-Q3: -9.3 to -1.0) vs non-improvement -1.0 (Q1-Q3: -5.0 to 2.5), P = 0.004) whereas change in LA size was not (OR: 0.98; 95% CI: 0.97-1.03; P = 0.984). CONCLUSIONS In patients with AF and LVSD, the degree of FMR did not impact the success of ablation. There was a significant reduction in FMR and FTR at 12 months following CA. Patients with AF and LVSD should be strongly considered for AF ablation irrespective of the degree of mitral regurgitation.
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Affiliation(s)
- Louise Segan
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Andrew Taylor
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Hare
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia
| | - Rose Crowley
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Jeremy William
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Kenneth Cho
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Michael Lim
- The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Youlin Koh
- The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Souvik Das
- The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Chieng
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Benedict Costello
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia
| | - David M Kaye
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Alex McLellan
- University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph B Morton
- University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- University of Melbourne, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter M Kistler
- The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Cabrini Hospital, Melbourne, Victoria, Australia; Melbourne Private Hospital, Melbourne, Victoria, Australia.
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Fava AM, Nakhla M, Hajj Ali A, Akintoye E, Akyuz K, Arockiam AD, Haroun E, El Dahdah J, Liao YWB, Popovic Z, Gillinov M, Pettersson G, Griffin B, Desai MY, Wang TKM. Atrial Functional Tricuspid Regurgitation: Contemporary Characteristics, Outcomes, and Novel Risk Score. JACC. ADVANCES 2025; 4:101623. [PMID: 40009906 PMCID: PMC11908566 DOI: 10.1016/j.jacadv.2025.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 01/14/2025] [Accepted: 01/17/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND Despite increasing clinical recognition of atrial functional tricuspid regurgitation (AF-TR), there remains limited literature regarding the characteristics, outcomes, and adverse prognosticators for this valve lesion. OBJECTIVES This study aimed to elucidate clinical and echocardiographic characteristics and outcomes and to develop a novel risk model in a large cohort of patients with significant AF-TR. METHODS Consecutive patients with at least moderate-to-severe AF-TR seen between January 2004 and December 2018 were retrospectively studied. Univariable and multivariable logistic regression (OR) were conducted to determine the risk factors and develop novel risk scores for 1-year all-cause mortality. RESULTS Among 370 patients with AF-TR (mean age 73.9 ± 15.0 years, 82.2% female; mean follow-up 4.1 ± 3.6 years), 1-year and total mortality occurred in 81 (21.9%) and 219 (59.2%) of patients respectively, with a median survival of 2.5 and 8.5 years for patients with AF-TR effective regurgitant orifice area ≥0.40 and <0.40 cm2. Multivariable analyses identified right heart failure (OR: 2.40; 95% CI: 1.31-4.41), lower serum albumin (OR: 0.88; 95% CI: 0.85-0.92), higher right atrial volume indexed (OR: 1.25; 95% CI: 1.04-1.49), lower tricuspid annular plane systolic excursion/right ventricular systolic pressure ratio (OR: 0.82; 95% CI: 0.70-0.95), and higher TR-effective regurgitant orifice area (OR: 1.11; 95% CI: 1.02-1.21) to be independently associated with 1-year mortality, from which a risk model was derived with good discrimination (area under the curve: 0.87). CONCLUSIONS Patients with AF-TR had poor prognosis especially if tricuspid regurgitation effective regurgitant orifice area was ≥0.40 cm2, validating the guidelines threshold for severe tricuspid regurgitation. A novel risk score for 1-year mortality in patients with AF-TR was developed, offering potential utility for risk stratification and treatment guidance; however, external validation is needed.
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Affiliation(s)
- Agostina M Fava
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Michael Nakhla
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Adel Hajj Ali
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Emmanuel Akintoye
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Kevser Akyuz
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Aro Daniela Arockiam
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Elio Haroun
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Yi-Wen Becky Liao
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, Ohio, USA.
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Hahn RT, Lindenfeld J, Böhm M, Edelmann F, Lund LH, Lurz P, Metra M, Tedford RJ, Butler J, Borlaug BA. Tricuspid Regurgitation in Patients With Heart Failure and Preserved Ejection Fraction: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:195-212. [PMID: 38960514 DOI: 10.1016/j.jacc.2024.04.047] [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: 02/07/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality. Important risk factors for the development of HFpEF are similar to risk factors for the progression of tricuspid regurgitation (TR), and both conditions frequently coexist and thus is a distinct phenotype or a marker for advanced HF. Many patients with severe, symptomatic atrial secondary TR have been enrolled in current transcatheter device trials, and may represent patients at an advanced stage of HFpEF. Management of HFpEF thus may affect the pathophysiology of TR, and the physiologic changes that occur following transcatheter treatment of TR, may also impact symptoms and outcomes in patients with HFpEF. This review discusses these issues and suggests possible management strategies for these patients.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Lars H Lund
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lurz
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | - Marco Metra
- CardiologyCardiology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Zhan Y, Li N. Sinus rhythm restoration reverses tricuspid regurgitation in patients with atrial fibrillation: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:411. [PMID: 38956670 PMCID: PMC11218105 DOI: 10.1186/s13019-024-02891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a common valvular heart disease worldwide, and current guidelines for TR treatment are relatively conservative, as well as with detrimental outcomes. Restoration of sinus rhythm was reported to improve the TR severity in those TR patients with atrial fibrillation (AF). However, relevant research was limited. The aim of this meta-analysis was to evaluate the clinical outcomes of restoration of sinus rhythm in TR patients with AF. METHODS In this study, PubMed, Web of Science, and Scopus databases were searched for study enrollment until July 2023. This study was designed under the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. These studies containing the patient's baseline characteristics, surgical procedure, and at least one of the clinical outcomes were included. The primary endpoint was TR grade during follow-up after restoration of sinus rhythm. RESULTS Out of 1074 records, 6 were enrolled. Restoration of sinus rhythm is associated with a reduction of TR severity (TR grade, odds ratio 0.11, 95% confidence interval (CI): 0.01 to 1.28, P = 0.08, I2 = 83%; TR area, mean difference (MD) -2.19 cm2, 95% CI: -4.17 to -0.21 cm2, P = 0.03, I2 = 96%). Additionally, remolding of right heart with a significant reduction of tricuspid valve annulus diameter (MD -0.36 cm, 95%CI: -0.47 to -0.26 cm, P < 0.00001, I2 = 29%) and right atrium volume index (MD -11.10 mL/m2, 95%CI: -16.81 to -5.39 mL/m2, P = 0.0001, I2 = 79%) was observed during follow-up. CONCLUSIONS In conclusion, rhythm-control therapy could reduce TR severity in AF patients with TR and is associated with right heart remodeling.
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Affiliation(s)
- Yufeng Zhan
- Department of Anesthesia, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, 310000, China
| | - Ning Li
- Department of Cardiothoracic Surgery, Naval Medical Center of PLA, Naval Medical University, Shanghai, 200052, China.
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7
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Ma C, Wu S, Liu S, Han Y. Chinese guidelines for the diagnosis and management of atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:714-770. [PMID: 38687179 DOI: 10.1111/pace.14920] [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: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 05/02/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of the guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice timely and fully, the Chinese Society of Cardiology of Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2‑VASc‑60 stroke risk score based on the characteristics of the Asian AF population. The guidelines also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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Affiliation(s)
- Changsheng Ma
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shulin Wu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shaowen Liu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Yaling Han
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
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8
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MA CS, WU SL, LIU SW, HAN YL, Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering. Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. J Geriatr Cardiol 2024; 21:251-314. [PMID: 38665287 PMCID: PMC11040055 DOI: 10.26599/1671-5411.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice in a timely and comprehensive manner, the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population. The guidelines have also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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9
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Cha MJ, Lee SA, Cho MS, Nam GB, Choi KJ, Kim J. Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation. Heart 2024; 110:523-530. [PMID: 37879881 DOI: 10.1136/heartjnl-2023-323244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity. METHODS A total of 106 patients with drug-refractory AF with moderate to severe secondary TR who underwent AF ablation were screened from a single-centre ablation registry. Echocardiographic parameter changes (pre-procedure vs 1 day/1 year post-procedure) were analysed. Holter monitoring was performed at 3/6/12 months to assess AF recurrence. The primary outcome was at least one grade TR reduction with its main determinants evaluated. RESULTS After excluding 36 patients (prior tricuspid valve surgery, intracardiac devices or insufficient data), 70 patients (aged 63.8±9.7 years, 50% female) were analysed. Of these, 17 (24.3%) had severe TR, 55 (78.6%) persistent AF and all restored sinus rhythm with catheter ablation. The primary outcome was achieved in 53 (75.7%) at 1-year assessment (73.6% of moderate and 82.4% of severe TR). There were significant decreases of vena contracta (6.1→3.2 mm) and tricuspid annular diameter (37.3→32.6 mm) at 1 year. Although 25 patients experienced AF recurrence within 1 year, 56 (80%) patients finally maintained sinus rhythm with medical treatment (87% in patients with TR reduction and 59% without). From the multivariate analysis, sinus rhythm maintenance was the most significant determinant of TR reduction (OR 8.3, 95% CI 1.8 to 37.4). CONCLUSION In patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction.
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Affiliation(s)
- Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Cardiac Imaging center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Min Soo Cho
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Kee-Joon Choi
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Atrial Fibrillation center, Heart institute, Asan Medical Center, Seoul, South Korea
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10
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 837] [Impact Index Per Article: 837.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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11
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 278] [Impact Index Per Article: 278.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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12
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Jou S, Liu Q, Gulsen MR, Biviano A, Wan EY, Dizon J, Saluja D, Garan H, Yarmohammadi H. Catheter ablation of typical atrial flutter improves cardiac chamber size and function. J Cardiovasc Electrophysiol 2024; 35:130-135. [PMID: 37975539 DOI: 10.1111/jce.16134] [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: 07/31/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) is one of the most common atrial arrhythmias involving the right atrium (RA) for which radiofrequency catheter ablation has been widely used as a therapy of choice. However, there is limited data on the effect of this intervention on cardiac size and function. METHODS A retrospective study was conducted on 468 patients who underwent ablation for CTI dependent typical AFL at a single institution between 2010 and 2019. After excluding patients with congenital or rheumatic heart disease, heart transplant recipients, or those without baseline echocardiogram, a total of 130 patients were included in the analysis. Echocardiographic data were analyzed at baseline before ablation, and at early follow-up within 1-year postablation. Follow-up echocardiographic data was available for 55 patients. RESULTS Of the 55 patients with CTI-AFL, the mean age was 64.2 ± 14.8 years old with 14.5% (n = 8) female. The average left ventricular ejection fraction (LVEF) significantly improved on follow-up echo (40.2 ± 16.9 to 50.4 ± 14.9%, p < .0001), of which 50% of patients had an improvement in LVEF of at least 10%. There was a significant reduction in left atrial volume index (82.74 ± 28.5 to 72.96 ± 28 mL/m2 , p = .008) and RA volume index (70.62 ± 25.6 to 64.15 ± 31 mL/m2 , p = .046), and a significant improvement in left atrial reservoir strain (13.04 ± 6.8 to 19.10 ± 7.7, p < .0001). CONCLUSIONS Patients who underwent CTI dependent AFL ablation showed an improvement in cardiac size and function at follow-up evaluation. While long-term results are still unknown, these findings indicate that restoration of sinus rhythm in patients with typical AFL is associated with improvement in atrial size and left ventricular function.
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Affiliation(s)
- Stephanie Jou
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Qi Liu
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mert R Gulsen
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jose Dizon
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deepak Saluja
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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13
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Schirmer SH, Bernat R. Can rhythm therapy cure valvular disease? J Interv Card Electrophysiol 2023; 66:1311-1312. [PMID: 36705870 PMCID: PMC10457224 DOI: 10.1007/s10840-023-01487-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Stephan H Schirmer
- Kardiopraxis Schirmer, Am Altenhof 8, 67655, Kaiserslautern, Germany.
- Saarland University, Homburg/Saar, Germany.
| | - Robert Bernat
- Marienhospital Aachen, Aachen, Germany
- Unversität Osijek, Osijek, Croatia
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14
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Nishiwaki S, Watanabe S, Yoneda F, Tanaka M, Aizawa T, Yamagami S, Komasa A, Kawaji T, Yoshizawa T, Kohjitani H, Morimoto T, Kimura T, Shizuta S. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1441-1453. [PMID: 36510108 DOI: 10.1007/s10840-022-01410-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated. METHODS We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6-18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up. RESULTS Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0-7.6] cm2 to 2.1 [1.1-3.1] cm2, P < 0.001). Moreover, mitral regurgitation jet area, left atrial area, mitral valve diameter, right ventricular end-diastolic area, right atrial area, and tricuspid valve diameter decreased at follow-up. CONCLUSIONS TR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.
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Affiliation(s)
- Shushi Nishiwaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan.
| | - Fumiya Yoneda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Munekazu Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | | | - Akihiro Komasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Tetsuma Kawaji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hirohiko Kohjitani
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
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15
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Hahn RT, Brener MI, Cox ZL, Pinney S, Lindenfeld J. Tricuspid Regurgitation Management for Heart Failure. JACC. HEART FAILURE 2023; 11:1084-1102. [PMID: 37611990 DOI: 10.1016/j.jchf.2023.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
There is growing evidence that severe tricuspid regurgitation (TR) impacts clinical outcomes in a variety of cardiovascular disease states. The late presentation of patients with advanced TR highlights the underappreciation of the disease, as well as the pitfalls of current guideline-directed medical management. Given the high in-hospital mortality associated with isolated tricuspid valve surgery, transcatheter options continue to be explored with the hope of improved survival and reduced heart failure hospitalizations. In this review, we explore the physiology of TR, discuss the etiologic classes of TR, and explore the transcatheter options for treatment and who might benefit from device therapy.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
| | - Michael I Brener
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Zachary L Cox
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Lipscomb University College of Pharmacy, Nashville, Tennessee, USA
| | - Sean Pinney
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, New York, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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Rajapreyar I, Soliman O, Brailovsky Y, Tedford RJ, Gibson G, Mohacsi P, Hajduczok AG, Tchantchaleishvili V, Wieselthaler G, Rame JE, Caliskan K. Late Right Heart Failure After Left Ventricular Assist Device Implantation: Contemporary Insights and Future Perspectives. JACC. HEART FAILURE 2023; 11:865-878. [PMID: 37269258 DOI: 10.1016/j.jchf.2023.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
Late right heart failure (RHF) is increasingly recognized in patients with long-term left ventricular assist device (LVAD) support and is associated with decreased survival and increased incidence of adverse events such as gastrointestinal bleeding and stroke. Progression of right ventricular (RV) dysfunction to clinical syndrome of late RHF in patients supported with LVAD is dependent on the severity of pre-existing RV dysfunction, persistent or worsening left- or right-sided valvular heart disease, pulmonary hypertension, inadequate or excessive left ventricular unloading, and/or progression of the underlying cardiac disease. RHF likely represents a continuum of risk with early presentation and progression to late RHF. However, de novo RHF develops in a subset of patients leading to increased diuretic requirement, arrhythmias, renal and hepatic dysfunction, and heart failure hospitalizations. The distinction between isolated late RHF and RHF due to left-sided contributions is lacking in registry studies and should be the focus of future registry data collection. Potential management strategies include optimization of RV preload and afterload, neurohormonal blockade, LVAD speed optimization, and treatment of concomitant valvular disease. In this review, the authors discuss definition, pathophysiology, prevention, and management of late RHF.
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Affiliation(s)
- Indranee Rajapreyar
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Osama Soliman
- Discipline of Cardiology, University Hospital Galway, School of Medicine, University of Galway, Ireland
| | - Yevgeniy Brailovsky
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory Gibson
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Mohacsi
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander G Hajduczok
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georg Wieselthaler
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, California, USA
| | - J Eduardo Rame
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
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17
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Ukita K, Egami Y, Nohara H, Kawanami S, Sugae H, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Predictors and outcomes of tricuspid regurgitation improvement after radiofrequency catheter ablation for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1360-1366. [PMID: 37149757 DOI: 10.1111/jce.15919] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). METHODS We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow-up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one-grade improvement of TR) and non-improvement of TR: IM group and Non-IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all-cause death) more than 12 months after the RFCA. RESULTS IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event-free survival than Non-IM group. CONCLUSIONS Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes.
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Affiliation(s)
- Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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18
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Kurita T. Tricuspid regurgitation, the last challenge left. J Cardiovasc Electrophysiol 2023; 34:1367-1369. [PMID: 37265019 DOI: 10.1111/jce.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Takashi Kurita
- Division of Cardiovascular Center, Kindai University, Osaka, Japan
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19
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Latib A, Mangieri A, Nettersheim FS, Baldus S. Transcatheter tricuspid valve repair/replacement should be offered to all patients with severe tricuspid regurgitation: pros and cons. EUROINTERVENTION 2023; 18:1395-1397. [PMID: 37092268 PMCID: PMC10111126 DOI: 10.4244/eij-e-22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Antonio Mangieri
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Felix Sebastian Nettersheim
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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20
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Wang TKM, Akintoye E. Atrial Functional Tricuspid Regurgitation: Do We Blame the AF, Right Atrium, or Both? JACC Cardiovasc Imaging 2022; 16:588-590. [PMID: 36752438 DOI: 10.1016/j.jcmg.2022.12.007] [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: 11/21/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Emmanuel Akintoye
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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21
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Murakami T, Nakamura N, Natsumeda M, Matsumoto S, Sakai K, Ohno Y, Nakazawa G, Shinozaki N, Ikari Y. Impact of tolvaptan on improvement of tricuspid regurgitation and right ventricular dimension in patients with right-sided heart failure. Heart Vessels 2022; 37:1153-1161. [PMID: 35050407 DOI: 10.1007/s00380-021-02014-7] [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: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
Managing right-sided chronic heart failure (CHF) due to tricuspid regurgitation (TR) remains a clinical challenge. Tolvaptan (TLV), a vasopressin V2 receptor inhibitor, is effective in controlling decompensated HF. However, its effects on right-sided CHF caused by TR are unclear. We sought to clarify the effects of TLV in CHF patients complicated with TR. The cohort consisted of 33 CHF patients with moderate or severe TR and permanent atrial fibrillation, who required hospitalization for HF. We observed 19 patients treated with TLV plus conventional therapies (TLV group) and 14 patients with conventional therapies alone (conventional group). Clinical characteristics, echocardiographic parameters, and laboratory data were investigated. Baseline characteristics were similar between groups. In the TLV group, the severity of TR at admission was 73.7% moderate and 26.3% severe. In the conventional group, these percentages were 85.7% and 14.3%, respectively. During the follow-up, the severity of TR improved in the TLV group (trivial-mild: 52.6%; moderate: 36.8%; severe: 10.5%) (p < 0.01). However, it did not improve in the conventional group (trivial-mild: 21.4%; moderate: 50.0%; severe: 28.6%) (p = 0.08). The diameter of the tricuspid annulus (p < 0.01), basal (p = 0.02), and mid right ventricle (p = 0.04) was reduced at follow-up in the TLV group. Nevertheless, these parameters did not change in the conventional group. Serum creatinine levels were maintained (p = 0.74) in the TLV group, but deteriorated in the conventional group (p = 0.03). TLV reduced right ventricular dimensions and improved TR without deterioration of renal function. Thus, TLV may be a new drug for the treatment of CHF patients with TR.
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Affiliation(s)
- Tsutomu Murakami
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Norihito Nakamura
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Makoto Natsumeda
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shingo Matsumoto
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Katsuaki Sakai
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Norihiko Shinozaki
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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22
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Gual-Capllonch F, Sáenz de Ibarra JI, Bayés-Genís A, Delgado V. Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men. Front Cardiovasc Med 2022; 9:877592. [PMID: 35770231 PMCID: PMC9234170 DOI: 10.3389/fcvm.2022.877592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022] Open
Abstract
Atrial functional regurgitation is caused by atrioventricular annulus dilation, with normal leaflets and ventricular dimensions and function within the normal range. Its occurrence, in both mitral and tricuspid valves, implies a worse prognosis due to the hemodynamic derangement they produce, but also constitutes a marker of greater comorbidity and more advanced disease. Predisposing conditions for these heart valve dysfunctions are mainly atrial fibrillation and heart failure with preserved ejection fraction. However, other factors like female sex also may be involved and influence their incidence, especially for atrial tricuspid regurgitation. In the present review, we analyze sex differences in the reported prevalence of atrial mitral and tricuspid regurgitation, and suggest possible mechanisms involved. Finally, we underline potential therapeutic and preventive strategies to reduce the burden of these heart valve disorders and discuss research gaps.
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Affiliation(s)
| | | | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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23
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Mohanty S, Natale A. Higher Hospitalization Rate and Impaired Quality of Life in the Presence of Severe Tricuspid Regurgitation in Patients With Newly Diagnosed Atrial Fibrillation: Is the Risk Real? J Am Heart Assoc 2022; 11:e025647. [PMID: 35383464 PMCID: PMC9238462 DOI: 10.1161/jaha.122.025647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute Austin TX.,Interventional Electrophysiology Scripps Clinic San Diego CA.,Case Western University Cleveland OH
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24
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Florescu DR, Muraru D, Volpato V, Gavazzoni M, Caravita S, Tomaselli M, Ciampi P, Florescu C, Bălșeanu TA, Parati G, Badano LP. Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore. J Clin Med 2022; 11:382. [PMID: 35054074 PMCID: PMC8781398 DOI: 10.3390/jcm11020382] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the "classical", ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.
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Affiliation(s)
- Diana R. Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Valentina Volpato
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pellegrino Ciampi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy
| | - Cristina Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Tudor A. Bălșeanu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luigi P. Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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25
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Martin AC, Bories MC, Tence N, Baudinaud P, Pechmajou L, Puscas T, Marijon E, Achouh P, Karam N. Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients. Front Cardiovasc Med 2021; 8:713658. [PMID: 34760937 PMCID: PMC8572852 DOI: 10.3389/fcvm.2021.713658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Atrioventricular regurgitation is frequent in the setting of heart failure. It is due to atrial and ventricular remodelling, as well as rhythmic disturbances and loss of synchrony. Once atrioventricular regurgitation develops, it can aggravate the underlying heart failure, and further participate and aggravate its own severity. Its presence is therefore concomitantly a surrogate of advance disease and a predictor of mortality. Heart failure management, including medical therapy, cardiac resynchronization therapy, and restoration of sinus rhythm, are the initial steps to reduce atrioventricular regurgitation. In the current review, we analyse the current data assessing the epidemiology, pathophysiology, and impact of non-valvular intervention on atrioventricular regurgitation including medical treatment, cardiac resynchronization and atrial fibrillation ablation.
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Affiliation(s)
- Anne-Céline Martin
- Paris University, INSERM UMRS_1140, Paris, France.,Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Marie-Cécile Bories
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France.,University of Paris, PARCC, INSERM, Paris, France
| | - Noemie Tence
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Pierre Baudinaud
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Louis Pechmajou
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Tania Puscas
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Eloi Marijon
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Paul Achouh
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Nicole Karam
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
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26
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Impact of atrial mitral and tricuspid regurgitation on atrial fibrillation recurrence after ablation. J Electrocardiol 2021; 66:114-121. [PMID: 33906059 DOI: 10.1016/j.jelectrocard.2021.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) induces functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) during atrial remodeling. FMR and FTR are associated with AF prognosis, but the effects for AF recurrence after ablation have not been determined conclusively. METHODS Two hundred thirty nine patients who underwent AF ablation were enrolled. Forty five patients were excluded. In total, 194 patients were analyzed. FMR and FTR were assessed by echocardiography. The left atrial volume index (LAVI) was evaluated by contrast-enhanced computed tomography. RESULTS Significant FMR and moderate FTR were observed in 15 (7.7%) and in 25 (12.9%) patients, respectively. The severity of tricuspid regurgitation (TR) significant correlated with age, NT-proBNP, and LAVI. During a 13.4 month follow-up period of, 39 patients (20.1%) demonstrated AF recurrence. In the Cox proportional-hazards model, E/e', FTR, and LAVI, were termed as predictor factors of AF recurrence (E/e'. hazard ratio [HR] = 1.117; P = 0.019, significant FTR. HR = 4.679; P = 0.041, LAVI. HR = 1.057; P = 0.003). Kaplan-Meier analysis showed that AF recurrence was more frequent in FTR compared with the nonsignificant FTR cases (log-rank, P = 0.001). Although survival analysis showed no difference with or without FMR, the presence of FMR and FTR was strongly associated with high-AF recurrence (log-rank, P = 0.004). CONCLUSIONS AF recurrence was associated with E/e', LAVI, and extensive FTR. Specifically, the combination of FTR and FMR markedly worsens the AF prognosis.
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