Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure

Santas, Enrique; Chorro, Francisco J.; Miñana, Gema; Méndez, José; Muñóz, J. Cuesta; Escribano, David; García‐Blas, Sergio; Valero, Ernesto; Bodı́, Vicent; Núñez, Eduardo; Sanchís, Juan; Núñez, Julio

doi:10.1253/circj.cj-15-0129

Cited by 30 publications

(29 citation statements)

References 36 publications

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“…TR causes fluid retention and systemic congestion, resulting in inflammation, neuro-hormonal activation, and multi-organ damage [24]. In HFpEF, TR is a strong predictor of death and rehospitalizations [13,25] and increases as RVD progresses over time [26]. In a recent meta-analysis including >30,000 patients with significant TR in different cardiac scenarios, TR was associated with an increased mortality risk independent of RV failure or PH [27].…”

Section: Discussionmentioning

confidence: 99%

“…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. Our aim was to create a comprehensive noninvasive staging system of progressive RVD features in HFpEF, integrating both TAPSE/PASP and TR, and to assess the impact of these stages on survival after a hospitalization for acute HF.…”

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Functional tricuspid regurgitation (TR) is a consequence of maladaptive RV remodeling and PH, leading to further RV enlargement and dysfunction in a vicious cycle [42]. Functional TR is a strong predictor of death and readmissions in HFpEF [54,55]. TR causes fluid retention, systemic congestion, and renal dysfunction, resulting in inflammation, neurohormonal activation, and multi-organ damage [42,56,57].…”

Section: Pulmonary Hypertension and Right Ventricular Dysfunctionmentioning

confidence: 99%

Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

Bayés‐Genís

Bisbal

Núñez

et al. 2020

JCM

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To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

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“…14 Tricuspid regurgitant (TR) pressure gradient, mitral flow early diastolic (E) velocity, as well as mitral flow to annular tissue velocity ratio (E/E') were used to describe HF severity. 15 …”

Section: MVmentioning

confidence: 99%

Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse　– Three-Dimensional Echocardiography –

Hayashi

Fukuda

Mahara

et al. 2016

Circ J

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Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure

Cited by 30 publications

References 36 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

Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse　– Three-Dimensional Echocardiography –

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Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure

Cited by 30 publications

References 36 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

Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse – Three-Dimensional Echocardiography –

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Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse　– Three-Dimensional Echocardiography –