BACKGROUND
The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated.
OBJECTIVES
This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort.
METHODS
Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention.
RESULTS
A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint.
CONCLUSIONS
The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
X. Galloo, M. Dietz, E. Prihadi et al.· JACC Cardiovascular Imaging· 0 citations
BACKGROUND
Cardiac resynchronization therapy (CRT) improves survival and symptoms in patients with heart failure with reduced ejection fraction and electromechanical dyssynchrony, yet up to 30-40% do not respond despite guideline-based selection. Hemodynamic forces (HDF) quantify intraventricular pressure gradients and can be derived from routine echocardiographic images. The aim of this study was to assess the predictive and prognostic value of HDF parameters in patients undergoing CRT and to investigate changes in HDF after CRT implantation.
METHODS
The following HDF parameters were assessed in 198 patients from the multicenter, prospective MARC study: (i) apical-basal force, (ii) latero-septal force (iii) their ratio (iv) force vector angle, (v) systolic apical-basal force, (vi) systolic angle. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume (LVESV) at 6 months. The composite outcome of all-cause mortality or cardiovascular hospitalization was analyzed using Cox regression models with long-term follow-up.
RESULTS
120 patients (60.6%) demonstrated echocardiographic response to CRT at 6 months. The addition of baseline systolic angle to clinical, electrocardiographic, and conventional echocardiographic markers of dyssynchrony significantly improved model fit for CRT response, although discrimination was not significantly improved. Responders showed significant improvement in HDF parameters after CRT, whereas no significant changes were observed in non-responders. During a median follow-up of 9.3 years, baseline systolic angle was independently associated with the composite endpoint of all-cause mortality or cardiovascular hospitalization and significantly improved risk stratification when added to established prognostic markers.
CONCLUSION
HDF parameters provide complementary descriptive insight into ventricular mechanics in patients undergoing CRT. Baseline systolic angle was independently associated with both reverse remodeling and long-term outcome, although discrimination was not significantly improved. While these findings suggest potential value for HDF assessment, further research is warranted to determine the clinical relevance in CRT patients.
R. Tarantini, W. Gerrits, C. Chiu et al.· Journal of the American Soci...· 0 citations
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