Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation

Zoghbi, William A.; Adams, David H.; Bonow, Robert O.; Enríquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton K.; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J.

doi:10.1016/j.echo.2017.01.007

Cited by 2,603 publications

(656 citation statements)

References 257 publications

Supporting

Mentioning

632

Contrasting

Unclassified

Order By: Relevance

“…Definite and borderline RHD were further classified into WHF sub-categories (A–C borderline, A–D definite) 9 . Mitral and aortic regurgitation and mitral stenosis were classified as trivial (only regurgitation), mild, moderate, or severe according to published standards 31, 32 . Children with definite RHD were classified by severity of regurgitation at the most affected valve (mild, moderate, severe), or severe if any mitral stenosis was present at baseline.…”

Section: Methodsmentioning

confidence: 99%

Latent Rheumatic Heart Disease

et al. 2017

View full text Add to dashboard Cite

Background Screening echocardiography (echo) has emerged as a potentially powerful tool for early diagnosis of rheumatic heart disease (RHD). The utility of screening echo hinges on the rate of RHD progression and the ability of penicillin prophylaxis to improve outcome. We report the longitudinal outcomes of a cohort of children with latent RHD and identify risk factors for unfavorable outcomes. Methods This was a prospective natural history study conducted under the Ugandan RHD registry. Children with latent RHD and ≥1 year of follow-up were included. All echos were re-reviewed by experts (2012 WHF criteria) for inclusion and evidence of change. Bi- and multi- variable logistic regression, Kaplan-Meier analysis, as well as Cox proportional hazard models were developed to search for risk factors for unfavorable outcome and compare progression-free survival between those treated and not treated with penicillin. Propensity and other matching methods with sensitivity analysis were implemented for the evaluation of the penicillin effect. Results Blinded review confirmed 227 cases of latent RHD: 164 borderline and 63 definite (42 mild, 21 moderate/severe). Median age at diagnosis was 12 years and median follow-up was 2.3 years (IQR 2.0–2.9). Penicillin prophylaxis was prescribed in 49.3% with overall adherence of 84.7%. Of children with moderate/severe definite RHD, 47.6% had echo progression (including 2 deaths), and 9.5% echo regression. Children with mild definite and borderline RHD showed 26% and 9.8% echo progression and 45.2% and 46.3% echo improvement respectively. Of those with mild definite RHD or borderline RHD, more advanced disease category, younger age, and morphological mitral valve features were risk factors for an unfavorable outcome. Conclusions Latent RHD is a heterogeneous diagnosis with variable disease outcomes. Children with moderate to severe latent RHD have poor outcomes. Children with both borderline and mild definite RHD are at substantial risk of progression. While long-term outcome remains unclear, the initial change in latent RHD may be evident during the first 1–2 years following diagnosis. Natural history data is inherently limited and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.

show abstract

Section: Methodsmentioning

confidence: 99%

Latent Rheumatic Heart Disease

et al. 2017

View full text Add to dashboard Cite

show abstract

“…It is known that RA/RV/inferior vena cava enlargement can occur in other conditions and can be normal in acute, severe TR. 44 TR assessment was by color flow Doppler and hepatic vein flow reversal, which can be less reliable in assessing TR grade in severe disease. The study established associations, but cause and effect cannot be implicated for altered anatomy.…”

Section: Study Limitationsmentioning

confidence: 99%

Pathogenic structural heart changes in early tricuspid regurgitation

Nemoto

Lesser

Pedersen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…This definition applies in both primary and secondary MR and is endorsed by the AHA/ACC 9. Moderate MR is defined as an RF between 30% and 50%, with moderate to severe taken as an RF between 40% and 50% 14. This latter term is often used in published studies of secondary MR, but it is seldom defined in specific terms.…”

Section: Quantification Of Secondary Mrmentioning

confidence: 99%

“…In secondary MR, this is largely a consequence of the fact that the orifice shape is non-circular with an oval or crescent shape. Indeed, the current ASE guidelines indicate that PISA definitions of severity in secondary MR are ‘problematic’ 14. Cardiac MRI may be the most reliable method to evaluate MR (vide infra), but this method needs further study in patients with secondary MR.…”

Section: Quantification Of Secondary Mrmentioning

confidence: 99%

Secondary mitral regurgitation (part 1): volumetric quantification and analysis

Gaasch

Meyer

2017

Heart

View full text Add to dashboard Cite

Secondary mitral regurgitation (MR) develops as a consequence of left ventricular (LV) dilatation and dysfunction, which complicates its evaluation and management. The goal of this article is to review the assessment of secondary MR with special emphasis on quantification and analysis of LV volume data. At the present time, the optimal method for making these measurements appears to be cardiac MRI. In severe MR (both primary and secondary), the regurgitant fraction (RF) exceeds 50%, and as a result, the LV end diastolic volume (EDV) is increased. In secondary MR, the ejection fraction is depressed (generally <40%) and despite an RF >50%, the regurgitant volume (RegV) rarely meets the current published criteria for severe MR (>60 mL). The ratio of the RegV to EDV, which is very low in secondary MR, reflects the effect of the RegV on the ventricle and it may be predictive of the fractional change in LV size that can be expected after correction of MR. Accurate measurement of the volumetric parameters is essential to proper management of patients with secondary MR.

show abstract

Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation

Cited by 2,603 publications

References 257 publications

Latent Rheumatic Heart Disease

Latent Rheumatic Heart Disease

Pathogenic structural heart changes in early tricuspid regurgitation

Secondary mitral regurgitation (part 1): volumetric quantification and analysis

Contact Info

Product

Resources

About