Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature

Hahn, Rebecca T.; Waxman, Aaron B.; Denti, Paolo; Delhaas, Tammo

doi:10.1001/jamacardio.2019.0535

Cited by 50 publications

(29 citation statements)

References 132 publications

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“…The final step of RVD is determined by the development of significant functional TR, reflecting the failure of the RV. Significant TR is a tipping point in the clinical evolution of patients with HFpEF [4,12,19,24]. In our opinion, the ominous prognosis of patients with both RV failure and significant TR in our cohort (stage 4) confirms the adequacy of this proposed staging system in HFpEF.…”

Section: Discussionsupporting

confidence: 75%

“…Characterization of HFpEF should ideally integrate metrics of RV and PA function, including tricuspid valve evaluation [3,19]. Given the fact that functional TR is usually the consequence of both RVD and PH, and its presence causally contributes to further RV remodeling, dysfunction, and progression of the disease [12,15], we believe a simple method integrating the continuum of RVD process in HFpEF, by combining metrics of RV, PA function, and tricuspid valve evaluation seems pertinent. All of these parameters should be used in evaluation and risk stratification, but also potentially as therapeutic targets in HFpEF, but ideally they should not be evaluated in isolation.…”

Section: Discussionmentioning

confidence: 99%

“…It is the pathophysiological consequence of both RV remodeling and PH, leading to further valve tethering and RV enlargement, resulting in more TR in a vicious cycle. Thus, TR is the consequence of RV-PA uncoupling and maladaptive RV remodeling [12,19,24]. Its clinical and prognostic value in HF should not be neglected.…”

Section: Discussionmentioning

confidence: 99%

“…The ratio of tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/PASP) measured by echocardiography has been proposed as a noninvasive index of RV-PA coupling, showing excellent correlations with PA compliance and distributing accordingly in the PA compliance and pulmonary vascular relationship by invasive data [10,11]. Functional tricuspid regurgitation (TR) is commonly the final consequence of right-side pressure overload and RV-PA uncoupling, leading to further RV remodeling and dysfunction, perpetuating the process [4,5,12]. All of these RV dysfunction (RVD) parameters have been shown to be strongly related to outcomes in HFpEF in isolation [8,10,[13][14][15], but little is known of the prognostic value of the interplay between them.…”

Section: Introductionmentioning

confidence: 99%

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Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Santas

Espriella

Chorro

et al. 2020

JCM

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Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP ≥ 0.36 without significant TR; stage 2: TAPSE/PASP ≥ 0.36 with significant TR; stage 3: TAPSE/PASP < 0.36 without significant TR; and stage 4: TAPSE/PASP < 0.36 with significant TR. By the 1 year follow-up, 207 (23.4%) patients had died. We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001). After multivariable adjustment, and compared to stage 1, stages 3 and 4 were independently associated with mortality risk (HR: 1.8219; 95% CI 1.308–2.538; p < 0.001 and HR = 2.2632; 95% CI 1.540–3.325; p < 0.001, respectively). A RVD staging system, integrating TAPSE/PASP and TR, provides a comprehensive and widely available tool for risk stratification in HFpEF.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Santas

Espriella

Chorro

et al. 2020

JCM

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“…TR leads to volume overload and further RV and RA dilation, resulting in annulus dilation, papillary muscle displacement and leaflet tethering, also influenced by elevated pulmonary artery pressure, further aggravating valve dysfunction (30,31). TR not only has a mechanical effect on the right heart structures, but also increases stiffness of the RA, possibly due to chronic inflammatory processes and formation of interstitial fibrosis (32).…”

Section: Etiology and Mechanisms Of Trmentioning

confidence: 99%

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Winkel

Brugger

Khalique

et al. 2020

Front. Cardiovasc. Med.

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With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.

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Impact of Right Ventricular to Pulmonary Artery Coupling on Survival Following Indirect Mitral Annuloplasty

Rottländer,

Golabkesh,

Degen

et al. 2024

Cathet Cardio Intervent

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BackgroundRight ventricular‐to‐pulmonary artery (RV‐PA) coupling is an important predictor of long‐term survival following transcatheter edge‐to‐edge repair. However, its impact on survival in patients undergoing indirect mitral annuloplasty is unknown. The study aimed to assess the impact of baseline RV‐PA coupling on survival following indirect mitral annuloplasty in heart failure patients.MethodsPatients were classified according to baseline RV‐PA coupling: TAPSE (tricuspid annular plane systolic excursion)/PASP (pulmonary artery systolic pressure) > 0.55 (group 1), ≤ 0.55 ≥ 0.32 (group 2) and ≤ 0.32 (group 3). Clinical follow‐up and RV function were assessed 3 and 12 months following indirect annuloplasty.ResultsA TAPSE/PASP > 0.55 was found in 19 patients, while 47 patients showed a TAPSE/PASP ≤ 0.55 > 0.32 and 26 a TAPSE/PASP ≤ 0.32. A significant reduction in vena contracta and regurgitant volume compared to baseline was found in all groups at 3‐months and 12‐months follow‐up. One‐year mortality was significantly increased in group 3 compared to the other groups (group 1: 0.95, group 2: 0.91, group 3: 0.77; Log‐Rank test p = 0.018). In groups 2 and 3 the TAPSE/PASP significantly improved during the 12‐months follow‐up, while it remained unchanged in group 1 (group 1: baseline = 0.71 ± 0.03, 12‐months = 0.67 ± 0.01; group 2: baseline = 0.43 ± 0.06, 12‐months: 0.56 ± 0.04; group 3: baseline = 0.25 ± 0.06, 12‐months: 0.4 ± 0.03; p < 0.001).ConclusionsRV‐PA uncoupling before indirect mitral annuloplasty is associated with poor survival. However, Carillon device implantation improved right heart function and RV‐PA coupling in patients with severe RV dysfunction at baseline. Therefore, Carillon device implantation can be a valuable option for transcatheter treatment of patients with FMR and right heart failure.

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Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature

Abstract: This narrative review describes the complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart, which lends insight into the functional changes seen with secondary tricuspid regurgitation.

Cited by 50 publications

References 132 publications

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Impact of Right Ventricular to Pulmonary Artery Coupling on Survival Following Indirect Mitral Annuloplasty

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