Andreas A Kammerlander1, Beatrice A Marzluf2, Alexandra Graf3, Alina Bachmann1, Alfred Kocher4, Diana Bonderman1, Julia Mascherbauer5. 1. Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 2. Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria. 3. Department of Medical Statistics, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 4. Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 5. Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: julia.mascherbauer@meduniwien.ac.at.
Abstract
BACKGROUND: Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear. OBJECTIVES: This study sought to assess the impact of significant TR late after left heart valve procedure. METHODS: A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months. RESULTS: Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation. CONCLUSIONS: RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure.
BACKGROUND: Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear. OBJECTIVES: This study sought to assess the impact of significant TR late after left heart valve procedure. METHODS: A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months. RESULTS: Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation. CONCLUSIONS: RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure.
Authors: Matthias Eberhard; Gianluca Milanese; Michael Ho; Stefan Zimmermann; Thomas Frauenfelder; Fabian Nietlispach; Francesco Maisano; Felix C Tanner; Thi Dan Linh Nguyen-Kim Journal: Eur Radiol Date: 2018-07-17 Impact factor: 5.315
Authors: Simone Romano; Davide Dell'atti; Robert M Judd; Raymond J Kim; Jonathan W Weinsaft; Jiwon Kim; John F Heitner; Rebecca T Hahn; Afshin Farzaneh-Far Journal: JACC Cardiovasc Imaging Date: 2021-04-14
Authors: Julia Mascherbauer; Andreas A Kammerlander; Beatrice A Marzluf; Alexandra Graf; Alfred Kocher; Diana Bonderman Journal: PLoS One Date: 2015-08-20 Impact factor: 3.240