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Gonzalez Gomez A, Hinojar R, Fernandez-Golfin C, Monteagudo JM, Garcia-Martin A, Gacia-Sebastian C, Garcia-Lunar I, Sanchez-Recalde A, Salido L, Pardo A, Zamorano JL. The 4A classification for patients with tricuspid regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Significant Tricuspid Regurgitation (TR) is associated with increased morbi-mortality. Clinical evaluation of TR patients is challenging.
Purpose
To establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its performance on prognosis.
Methods
Consecutive patients with isolated at least severe TR and absence of episodes of heart failure (HF) evaluated in the Heart Valve Clinic were included. Signs and symptoms of Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia where registered, follow up was performed every 6 months. 4A classification ranged from A0 (no A) to A4 (three or four A's present). A combined endpoint of hospital admission due to right HF and cardiovascular mortality was defined.
Results
135 patients with significant TR between 2016 and 2021 were included (69% females, mean age was 78±7 years). During a median follow-up of 26 months (IQR: 10–41 months), n=53 patients (39%) reached the combined endpoint. 52 (38%) admitted for heart failure and 11% (n=15) died. At baseline 94% of patients were in NYHA I or II whereas 24% presented A2 or A3. The presence of A2 or A3 showed a high incidence of events (figure). The change in 4A class and GGT remained independent predictor of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class 1.95 [1.37–2.77], p<0.001)
Conclusions
For the first time, we show the use of a new clinical classification, specific for patients with TR based on signs and symptoms of right HF that is prognostic of events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - R Hinojar
- Ramon and Cajal University Hospital , Madrid , Spain
| | | | | | | | | | | | | | - L Salido
- Ramon and Cajal University Hospital , Madrid , Spain
| | - A Pardo
- Ramon and Cajal University Hospital , Madrid , Spain
| | - J L Zamorano
- Ramon and Cajal University Hospital , Madrid , Spain
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Pardo Sanz A, Santoro C, Hinojar R, Rajjoub E, Pascual M, Salido L, Gonzalez A, Garcia A, Jimenez JJ, Casas E, Abellas M, Hernandez S, Hernandez R, Zamorano JL, Fernandez-Golfin C. P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use.
The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters.
Methods
Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22.
Results
The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1.
Prevalence of RV dysfunction
Conclusions
The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.
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Affiliation(s)
- A Pardo Sanz
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Santoro
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Rajjoub
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Pascual
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - L Salido
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Gonzalez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J J Jimenez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Casas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - S Hernandez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hernandez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
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Santoro C, Pardo A, Hinojar R, Garcia A, Salido L, Gonzalez-Gomez A, Jimenez-Nacher JJ, Marco Del Castillo A, Abellas M, Hernandez-Antolin R, Zamorano JL, Fernandez-Golfin C. 2139Left atrial dysfunction assessed by strain correlates with symptoms and severity of aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) results in high pressure afterload causing detrimental effect especially on the left chambers. Structural and functional changes of the left ventricle (LV) usually corresponds to concomitant remodelling of the left atrium (LA). However, how this pressure afterload specifically affects LA function and whether the study of LA function could help in stratifying patients with different degree of AS it is not known.
Purpose
We aim to evaluate the differences in LA and LV function according different degree of AS by standard and speckle tracking echocardiographic.
Methods
From January 2016 to May 2018 we recruited 135 patients referring to our echo-lab with diagnosis of AS (mean age 79.5±4.4; 60/55% female). We divided this population according to AS severity in patients with moderate AS, severe asymptomatic and severe symptomatic AS and matched with 35 control group with no aortic stenosis (n=45, mean age: 77.6±4.5). All patients underwent standard and 2-dimensional speckle tracking echocardiography computing global longitudinal strain (GLS) of LV and peak atrial strain of LA (PALS).
Results
In all patients PALS was a good predictor of E/e' ratio after correction for LV EF and age (p<0.001, β: −0.48). LVEF and GLS progressively decreased together with worsening of AS degree, as well as parameters of geometry and function of LA (Table1). By excluding patients with LV dysfunction the reduction gradient of parameters of LA geometry and function was still present. However, when severe symptomatic with asymptomatic severe AS are compared, no difference in E/e' ratio was found while both GLS and PALS were significantly reduced (both p<0.0001).
Variables Overall population (180) Control (45) Moderate AS (45) Severe asympt AS (45) Severe sympt. AS (45) p LVEF 65.0±11.1 67.7±5.6 69.4±8.5 66.1±10.7 59.5±13.5 0.0001 GLS −20.4±4.1 −23.1±2.4 −21.5±2.9 −21.4±3.2 −17.1±4.3 0.0001 LA vol index 41.6±21.5 28.2±10.4 40.1±19.7 39.8±16.7 52.3±24.9 0.0001 LA strain 23.6±10.9 30.8±10.3 27.8±9.2 24.4±9.7 15.2±7.1 0.0001 LA reservoir 46.4±15.9 51.9±11.5 53.0±15.0 48.3±14.1 37.2±16.1 0.0001 Ee' ratio 14.8±7.0 9.6±2.7 13.7±6.3 15.4±6.2 19.3±7.2 0.0001
Conclusions
LA function seems to progressively decrease according to the degree of AS, independently from LV function. Significant difference was found between parameters of LA remodelling and dysfunction between symptomatic and asymptomatic AS patients. The assessment of LA function by strain may help stratify the patients with AS, identifying those who need intensive medical/surgical treatment.
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Affiliation(s)
- C Santoro
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - A Pardo
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - L Salido
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Gonzalez-Gomez
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - J J Jimenez-Nacher
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Marco Del Castillo
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - R Hernandez-Antolin
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
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Wassmuth R, Hristova K, Monney P, Olander RFW, Rodriguez Munoz D, Huayan X, Pagourelias E, Loardi C, Moreno J, Miljkovic T, Takase H, Latet SC, Henquin R, America R, Carter-Storch R, Panelo ML, Fernandez-Golfin C, Cho IJ, Petrini J, Buonauro A, Liu B, Mapelli M, Tamulenaite E, De Chiara B, Minden H, Kostova V, Nesheva N, Katova TZ, Bojadzhiev L, Crisinel V, Reverdin S, Conti L, Mach F, Mueller H, Jeanrenaud X, Bochud M, Ehret G, Sundholm JKM, Ojala T, Andersson S, Sarkola T, Moya Mur JL, Berlot B, Fernandez-Golfin C, Moreno Planas J, Casas Rojo E, Garcia Martin A, Jimenez Nacher JJ, Hernandez-Madrid A, Franco Diez E, Matia Frances R, Zamorano JL, Zhigang YANG, Yingkun GUO, Jing CHEN, Duchenne J, Mirea O, Triantafyllis A, Michalski B, Vovas G, Delforge M, Van Cleemput J, Bogaert J, Voigt JU, Saccocci M, Tamborini G, Veglia F, Pepi M, Alamanni F, Zanobini M, Zuniga Sedano JJ, Alexanderson E, Martinez C, Bjelobrk M, Pavlovic K, Ilic A, Colakovic S, Dodic S, Tanaka T, Machii M, Nonaka D, Van Herck PL, Claeys MJ, Haine SE, Miljoen HP, Segers VF, Vandendriessche TR, De Winter BY, Hoymans VY, Vrints CJ, Lombardero M, Perea G, Miele MM, De Amicis DAV, Mannacio VAM, Dahl JS, Christensen NL, Soendergaard EV, Marcussen N, Moeller JE, Fernandez-Palomeque C, Garcia-Vega D, Mont-Girbau L, Pardo A, Izurieta C, Boretti I, Hinojar R, Gonzalez-Gomez A, Garcia Martin A, Casas E, Salido L, Barrios V, Ruiz S, Moya JL, Hernandez Antolin R, Jimenez Nacher JL, Zamorano JL, Chang HJ, Choi HH, Lee SY, Shim CY, Ha JW, Chung N, Ring M, Caidahl K, Eriksson MJ, Esposito R, Santoro C, Monteagudo JM, Trimarco B, Galderisi M, Zamorano JL, Baig S, Hayer M, Steeds R, Edwards N, Fusini L, Zagni P, Muratori M, Agostoni P, Tamborini G, Gripari P, Ghulam Ali S, Pepi M, Fiorentini C, Valuckiene Z, Jurkevicius R, Peritore A, Botta L, Belli O, Musca F, Casadei F, Russo C, Giannattasio C, Moreo A. Poster Session 6Assessment of morphology and functionP1222Multimodality imaging for left atrial appendage occluder sizingP1223Longitudinal left atrial strain is a main predictor for long term prognosis on atrial fibrillation after CABG operation patientsP1224Comparison of 2D and 3D left ventricular volumes measurements: results from the SKIPOGH II studyP1225Adjusting for thoracic circumference is superior to body surface area in the assessment of neonatal cardiac dimensions in foetal growth abnormalityP1226Maximal vortex suction pressure: an equivocal marker for optimization of atrio-ventricular delayP1227Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitusP1228Thickness matters, but not in the same way for all strain parametersP1229Digging deeper in postoperative modifications of right ventricular function: impact of pericardial approach and cardioplegiaP1230Left atrial function evaluated by 2D-speckle tracking echocardiography in diabetes mellitus populationP1231The influence of arterial hypertension duration on left ventricular diastolic parameters in patients with well regulated arterial blood pressureP1232Investigation of factors affecting left ventricular diastolic dysfunction determined using mitral annulus velocityP1233High regulatory T-lymphocytes after ST-elevation myocardial infarction relate with adverse left ventricular remodelling assessed by 3D-echocardiographyP1234Prevalence of paradoxical low flow/low gradient severe aortic stenosis measure with 3 dimensional transesophageal echocardiographyP1235Coronary microvascular and diastolic dysfunctions after aortic valve replacement: comparison between mechanical and biological prosthesesP1236Normal-flow, low gradient aortic stenosis is common in a population of patients with severe aortic valve stenosis undergoing aortic valve replacementP1237Analysis of validity and reproducibility of calcium burden visual estimation by echocardiographyP12383D full automatic software in the evaluation of aortic stenosis severity in TAVI patients. Preliminary resultsP1239Differential impact of net atrioventricular compliance on clinical outcomes in patients with mitral stenosis according to cardiac rhythmP1240Aortic regurgitation affects the intima-media thickness of the right and left common carotid artery differentlyP1241Global longitudinal strain: an hallmark of cardiac damage in mitral valve regurgitation. Experience from the european registry of mitral regurgitationP1242Echocardiographic characterisation of Barlow's disease versus fibroelastic deficiencyP1243Echocardiographic screening for rheumatic heart disease in a ugandan orphanage - feasibility and outcomesP1244Alterations in right ventricular mechanics upon follow-up period in patients with persistent ischemic mitral regurgitation after inferoposterior myocardial infarctionP1245Ten-years conventional mitral surgery in patients with mitral regurgitation and left ventricular dysfunction: clinical and echocardiographic outcomes. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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