Yang Zhan1, Dany Debs2, Mohammad A Khan2, Duc T Nguyen3, Edward A Graviss4, Shaden Khalaf2, Stephen H Little2, Michael J Reardon2, Sherif Nagueh2, Miguel A Quiñones2, Neal Kleiman2, William A Zoghbi2, Dipan J Shah5. 1. Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Department of Cardiology, Regina General Hospital, University of Saskatchewan, Regina, Saskatchewan, Canada. 2. Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. 3. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas. 4. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas. 5. Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. Electronic address: djshah@houstonmethodist.org.
Abstract
BACKGROUND: Quantitation of tricuspid regurgitant (TR) severity can be challenging with conventional echocardiographic imaging and may be better evaluated using cardiovascular magnetic resonance (CMR). OBJECTIVES: In patients with functional TR, this study sought to examine the relationship between TR volume (TRVol) and TR fraction (TRF) with all-cause mortality. METHODS: We examined 547 patients with functional TR using CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. Thresholds for mild, moderate, and severe TR were derived based on natural history outcome data. RESULTS: During a median follow-up of 2.6 years (interquartile range: 1.7 to 3.3 years), there were 93 deaths, with an estimated 5-year survival of 79% (95% confidence interval [CI]: 73% to 83%). After adjustment of clinical and imaging variables, including RV function, both TRF (adjusted hazard ratio [AHR] per 10% increment: 1.26; 95% CI: 1.10 to 1.45; p = 0.001) and TRVol (AHR per 10-ml increment: 1.15; 95% CI: 1.04 to 1.26; p = 0.004) were associated with mortality. Patients in the highest-risk strata of TRVol ≥45 ml or TRF ≥50% had the worst prognosis (AHR: 2.26; 95% CI: 1.36 to 3.76; p = 0.002 for TRVol and AHR: 2.60; 95% CI: 1.45 to 4.66; p = 0.001 for TRF). CONCLUSIONS: This is the first study to use CMR to assess independent prognostic implications of functional TR. Both TRF and TRVol were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction. A TRVol of ≥45 ml or TRF of ≥50% identified patients in the highest-risk strata for mortality. These CMR thresholds should be used for patient selection in future trials to determine if tricuspid valve intervention improves outcomes in this high-risk group.
BACKGROUND: Quantitation of tricuspid regurgitant (TR) severity can be challenging with conventional echocardiographic imaging and may be better evaluated using cardiovascular magnetic resonance (CMR). OBJECTIVES: In patients with functional TR, this study sought to examine the relationship between TR volume (TRVol) and TR fraction (TRF) with all-cause mortality. METHODS: We examined 547 patients with functional TR using CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. Thresholds for mild, moderate, and severe TR were derived based on natural history outcome data. RESULTS: During a median follow-up of 2.6 years (interquartile range: 1.7 to 3.3 years), there were 93 deaths, with an estimated 5-year survival of 79% (95% confidence interval [CI]: 73% to 83%). After adjustment of clinical and imaging variables, including RV function, both TRF (adjusted hazard ratio [AHR] per 10% increment: 1.26; 95% CI: 1.10 to 1.45; p = 0.001) and TRVol (AHR per 10-ml increment: 1.15; 95% CI: 1.04 to 1.26; p = 0.004) were associated with mortality. Patients in the highest-risk strata of TRVol ≥45 ml or TRF ≥50% had the worst prognosis (AHR: 2.26; 95% CI: 1.36 to 3.76; p = 0.002 for TRVol and AHR: 2.60; 95% CI: 1.45 to 4.66; p = 0.001 for TRF). CONCLUSIONS: This is the first study to use CMR to assess independent prognostic implications of functional TR. Both TRF and TRVol were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction. A TRVol of ≥45 ml or TRF of ≥50% identified patients in the highest-risk strata for mortality. These CMR thresholds should be used for patient selection in future trials to determine if tricuspid valve intervention improves outcomes in this high-risk group.
Authors: Habib Layoun; Paul Schoenhagen; Tom Kai Ming Wang; Rishi Puri; Samir R Kapadia; Serge C Harb Journal: Curr Cardiol Rep Date: 2021-07-16 Impact factor: 2.931
Authors: Pedro Covas; Haneen Ismail; Joseph Krepp; Brian G Choi; Jannet F Lewis; Richard J Katz; Andrew D Choi Journal: Curr Treat Options Cardiovasc Med Date: 2021-03-15
Authors: Mahesh K Vidula; Ziqian Xu; Yuanwei Xu; Abdullah Alturki; Bhavana N Reddy; Prayaag Kini; Angel L Alberto-Delgado; Ron Jacob; Tiffany Chen; Victor A Ferrari; Lilia M Sierra-Galan; Yucheng Chen; Sanjaya Viswamitra; Yuchi Han Journal: J Cardiovasc Magn Reson Date: 2022-04-07 Impact factor: 6.903