Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Abstract

Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.

The clinical relevance of laboratory prognostic scores for patients with radiosurgically treated brain metastases of non-pulmonary primary tumor

“…Systemic inflammation was identified to be associated with cancer development, metastasis and progression. Similarly, markers of inflammation, such as CRP, albumin or leucocyte-based ratios, were shown to predict tumor progression in a variety of solid tumors [ 6 , 8 , 13 , 14 , 21 , 22 ]. So far, data on radiosurgically treated BM patients remain scarce [ 5 , 8 ].…”

“…Recently, several laboratory prognostic predictors for solid and metastatic cancer patients have additionally gained interest due to their simplicity and wide availability [ 3 – 5 ]. Therefore, leucocyte-based ratios, such as the Neutrophil-to-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), and the Lymphocyte-to-Monocyte Ratio (LMR), have been previously reported to be prognostic for overall survival in patients with surgically treated BM [ 4 , 6 ]. However, the clinical data on NLR, PLR and LMR for radiosurgically treated BM patients are still mainly limited to non-small cell lung cancer (NSCLC) patients [ 7 – 9 ].…”

Prognostic impact of functional mitral regurgitation prior to left ventricular assist device implantation

“…Despite presumably elevated left-sided filling pressures and pulmonary congestion due to FMR [ 29 ] in the MR-group , systolic RV function (measured as TAPSE) prior to LVAD implantation was comparable in both study-groups. Nevertheless, the increased prevalence of significant FTR within the MR-group might impact the assessment of RV function as severe pendulous volume caused by atrio-ventricular regurgitation potentially leads to hyperdynamic RV function to maintain sufficient stroke volume [ 30 ].…”