Tricuspid regurgitation occurring in the early‐diastolic phase in a case of heart failure: Insights from echocardiographic and invasive hemodynamic findings

Murayama, Michito; Iwano, Hiroyuki; Tsujinaga, Shingo; Sarashina, Miwa; Ishizaka, Shoji; Chiba, Yukio; Nakabachi, Masahiro; Yokoyama, Shinobu; Nishino, Hisao; Okada, Kazunori; Kaga, Sanae; Shibuya, Hitoshi; Nishida, Mutsumi; Anzai, Toshihisa

doi:10.1111/echo.14458

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Therefore, a VMT score of 2 consisted of two components: simultaneous atrioventricular valve opening with a dilated IVC (VMT score 2a) and earlier MV opening without a dilated IVC (VMT score 2b; Figures 1C and D). Theoretically, this score increases in accordance with the elevation of PAWP because the pressure crossover between the left atrium and the decay of the left ventricle happens earlier with the increase in the LA peak v pressure, which causes PAWP elevation, 14,15 and also the relative timing of atrioventricular valve opening depends on the relationship between RA and LA pressures. 9 Figure 1 VMT scoring.…”

Section: Vmt Scoringmentioning

confidence: 93%

“…Although early diastolic opening of the TV precedes that of the MV in normal conditions, 9,17 once LVFP is elevated, MV opening happens early and precedes TV opening, resulting from early crossover of LA and LV pressures. 9,14,15 Reduced RV relaxation due to postcapillary pulmonary hypertension also accentuates this time sequence. 9,18 Accordingly, early MV opening is considered to reflect the degree of LVFP elevation.…”

Section: Physiological Background Of the Vmt Scorementioning

confidence: 98%

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Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

Murayama

Iwano

Nishino

et al. 2021

Journal of the American Society of Echocardiography

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Background: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure.Methods: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) $ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography.Results: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 6 5; score 1, 12 6 4; score 2, 22 6 8; score 3, 28 6 4 mm Hg; P < .001, analysis of variance). VMT score $ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guidelinerecommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score $ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores $ 2 were at higher risk for cardiac events than those with VMT scores # 1 (P < .001).Conclusions: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.

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Section: Vmt Scoringmentioning

confidence: 93%

Section: Physiological Background Of the Vmt Scorementioning

confidence: 98%

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

Murayama

Iwano

Nishino

et al. 2021

Journal of the American Society of Echocardiography

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“…21 In normal circumstances, the early diastolic opening of the TV precedes that of the MV, but as a major factor for HF, once LVFP is elevated, MV opening happens early and precedes TV opening, resulting from an early crossover of LA and LV pressures. 22,23 The increase of LVFP can also lead to secondary postcapillary pulmonary hypertension, resulting in increased right ventricular pressure, impaired right ventricular diastolic function, and prolonged right ventricular diastolic time. 24 The time delay of RV inflow relative to the LV inflow, as evaluated by the dual-Doppler system, was found to be an index of LVFP in patients with HF.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of the visually assessed time difference between mitral valve and tricuspid valve opening score for patients with heart failure with mildly reduced ejection fraction

Yue,

Wu,

Guan

et al. 2024

Clinical Cardiology

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BackgroundThe visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score was correlated with the increase of left ventricular filling pressure (LVFP).HypothesisWe suspected that the VMT score might be a valuable prognostic biomarker for heart failure with mildly reduced ejection fraction (HFmrEF) patients. This study was to evaluate the predictive value of VMT score for 1‐year all‐cause and cardiovascular disease (CVD)‐cause mortality in HFmrEF patients.MethodsThis cohort study enrolled 379 patients aged ≥18 years old with HFmrEF. Univariable and multivariable Cox regression analysis was employed to assess the association between VMT score and all‐cause or CVD‐cause mortality in HFmrEF patients. Hazards ratio (HR), and 95% confidence interval (CI) were effect sizes. Kaplan–Meier curves showed the survival probability of patients. The area under the curve (AUC) evaluated the prognostic value of the VMT score.ResultsThe risk of all‐cause mortality was increased in HFmrEF patients in the VMT score of 2 (HR = 2.80, 95%CI: 1.04–7.52) and 3 (HR = 4.29, 95%CI: 1.58–11.66). The VMT score of 3 was associated with an increased risk of 1‐year CVD‐cause mortality in patients with HFmrEF (HR = 7.63, 95%CI: 1.70–34.33). The AUC of VMT score for predicting 1‐year all‐cause mortality of HFmrEF patients was 0.724, and for predicting 1‐year CVD‐cause mortality of HFmrEF patients was 0.748. The survival probability of patients with the VMT score < 2 was higher than those with the VMT score of 2 and 3.ConclusionThe VMT score might be a reliable prognostic index for 1‐year all‐cause or CVD‐cause mortality of HFmrEF patients.

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“…With the increase of PVR, the waveform peak of Qti changes from "E peak" to "A peak, " which indicates that PVR can affect the right ventricular function to some extent. In reference (Murayama et al, 2019), the ratio of velocity between "E peak" and "A peak" is used to quantify the ventricular diastolic function.…”

Section: Discussionmentioning

confidence: 99%

Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

Qiao

Yang

et al. 2020

Front. Physiol.

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Objective: The one and a half ventricle repair (1.5VR) is a common clinical choice for patients with right heart dysfunction. Considering the influence of blood circulation failure and reoperation in urgent need, this essay aims to explore the hemodynamic effects of different pulmonary vascular resistance (PVR) values on reoperation after 1.5VR failure. Methods: The lumped parameter model (LPM) was used to simulate the reoperation, including the return biventricular repair (2VR), ligation of azygos vein (1.5VR) and return single ventricular repair (1.0VR). Firstly, the debugging parameters were used to simulate the hemodynamics of 2VR. Secondly, the value of PVR was changed from one to four times while the other parameters remained unchanged. Finally, 15 cardiac cycles were simulated and the 15th result was obtained. In this work, the left and right ventricular stroke work and their sum (Plv, Prv, Ptotal), the left and right ventricular ejection fraction (LVEF, RVEF), the mean Cardiac Output (mCO) and the mean pressure and flow-rate ratio of superior and inferior vena cava (mPsvc\mPivc and mQsvc\mQivc), respectively, were used to describe the hemodynamics of reoperation. Results: With the change of PVR from one to four times, the values of Plv, Prv, Ptotal, LVEF, and RVEF gradually decreased. The change rate of Plv, Ptotal and LVEF of 1.0VR were the largest in the three kinds of reoperation. The change rate of Prv of 1.5VR was larger than that of 2VR, but it was the opposite for their EF change rate. The mCO of 2VR, 1.5VR , and 1.0VR decreased by 18.53%, 37.58%, and 48.07%, respectively. The mPsvc\mPivc of 1.5VR increased from 3.76 to 6.77 and the mQsvc\mQivc decreased from 0.55 to 0.36, while the mPsvc\mPivc and mQsvc\mQivc of 2VR and 1.0VR remained 1 and 0.67, respectively. The peak value of the tricuspid flow-rate (Qti) waveform of 2VR and 1.5VR changed from "E peak" to "A peak."

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Tricuspid regurgitation occurring in the early‐diastolic phase in a case of heart failure: Insights from echocardiographic and invasive hemodynamic findings

Cited by 4 publications

References 11 publications

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

The prognostic value of the visually assessed time difference between mitral valve and tricuspid valve opening score for patients with heart failure with mildly reduced ejection fraction

Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

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