Severity Of TR Research Articles

0118: Right ventricular dysfunction in severe tricuspid regurgitation

The relationship between right ventricular function and severe tricuspid regurgitation is intricate: severe TR can lead to right ventricle dysfunction and changes in right ventricle morphology can aggravate a tricuspid regurgitation. Establish a correlation between regional and global right ventricular (RV) function parameters and TR severity. Forty consecutive patients with TR and left ventricle valve disease were enrolled prospectively (mean age: 54±16 years; 23 males), TR was evaluated according to EACVI recommendations by PISA method. Regional right systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) and systolic tissue Doppler velocity measured at the lateral tricuspid annulus (S’) and global RV function assessed by fractional area change (FAC) were measured for all patients. Patients were divided into two groups according to the severity of TR. Ten patients (25%) had severe TR (G1) and 30 patients (75%) had mild or moderate TR (G2). FAC was lower in G1 compared to G2 (24.7±7.4% vs 40.4±10.1%, p<0.0001; respectively). TAPSE was 14.3±3.6mm in G1 vs 17.7±2.6mm in G2, p?0.002 and S’ was 9.7±1.0cm/s in G1 vs 11.7±1.4 cm/s in G2, p<0.0001. There was a significant negative correlation between EROA and FAC, TAPSE and S’ with r = -0.58, p<0.0001; r = -0.48, p= 0.001 and r = -0.69, p<0.0001 respectively. Regional and global RV function are impaired alike in severe TR.

752 Should Advanced Age Be a Contra-Indication to LVAD Implant: A Community Hospital Experience

with refractory Stage D heart failure. Methods and Materials: MEDAMACS (n 168) enrolled adult patients with CHF on optimal therapy, LVEF 30%, and 2 hospitalizations in the past year or 1 hospitalization and 1 high risk feature. Echo-determined severity of TR (none, mild, moderate, severe) was reported in 166 of 168 patients. With an endpoint of survival free of inotrope dependence, mechanical circulatory support (MCS), or heart transplantation, we tested the predictive value of at least moderate TR in adjusted analyses. Results: Moderate TR was present in 30% and severe TR in 15% of the study cohort. The presence of greater than moderate TR was associated with right atrial pressure (p 0.0006), pulmonary artery mean pressure (p 0.03), TR velocity (p 0.01), inspiratory collapse of the inferior vena cava (p 0.01), RVD(p 0.04), peripheral edema (p 0.0003), hepatosplenomegaly (p 0.01), low platelets (p 0.05), and total bilirubin (p 0.03). Over a mean follow-up of 154 days, 64 events were recorded including long term inotropic support (9), MCS (16), cardiac transplantation (17), and mortality (22). In univariate analysis, at least moderateTR was associated with increased risk (OR 3.1; 95% CI 1.6, 6.0; p 0.0006). After multivariate adjustment, tricuspid regurgitation remained independently associated with survival free of transplant, MCS, or inotropic dependence (OR 3.5; 95% CI 1.5, 8.6; p 0.004). Conclusions: Tricuspid regurgitation is common and carries prognostic import in Stage D Heart Failure. Given the importance of TR when considering left ventricular assist device support, future studies should investigate the reversibility of this lesion.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p&lt;0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p&lt;0,001) and linearly negative correlate with RVDd (r= -0.39; p&lt;0.01), RVDd/LVDd (r=-0.33; p&lt;0.01), RA size (r=-0.35; p&lt;0.01), TR (r=-0.26; p&lt;0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p&lt;0.001) and linearly negative correlate with RVDd (r= -0.39; p&lt;0.01), RVDd/LVDd (r=-0.33; p&lt;0.01), RA size (r=-0.35; p&lt;0.01), TR (r=-0.26; p&lt;0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

37 Tricuspid Valve Insufficiency in Patients with Axial-flow Left Ventricular Assist Devices

graphic criteria: 1) pre-VAD implantation, 2) post-implantation, 3) longterm follow-up (238 184 days). Post-operative RV dysfunction was medically managed. Results: A significant improvement in TR resulted following VAD implantation (p 0.005) and was sustained long-term (p 0.005). Improvements in RV function were not immediately apparent, but improved significantly long-term following continuous flow VAD implantation (p 0.01). Significant improvements in mean pulmonary artery pressure (28 9 vs. 26 6 mmHg, p 0.01) and right ventricular stroke work index (5.9 3.3 vs 7.0 3.5 gm-m/m2/beat, p 0.05) were evident post-VAD implantation. 91% of patients were discharged (ICU LOS 8.4 7.4 days; hospital LOS 29 17 days). Conclusions: TR may be managed non-operatively during continuous flow VAD implantation. Severity of functional TR and RV dysfunction appear to improve following continuous flow VAD implantation.

The Sunshine Coast STEMI Pilot: An Integrated Network Model for Immediate Transfer of Regional patients to a PCI-Capable Hospital

criteria. Pearson’s coefficient was used to determine correlation between the two methods for each category of TR. Results: 108 RHC studies were included for analysis. Pearson’s coefficient of correlation for each subgroup; overall cohort: 0.829 (p< 0.001), trivial or no TR (n= 25): 0.880 (p< 0.001), 1/4 TR (n= 37): 0.816 (p< 0.001), 2/4 TR (n= 33): 0.729 (p< 0.001), 3/4 or worse TR (n= 12): 0.936 (p< 0.001). Conclusion: There is good correlation between Fick and thermodilution measures of CO independent of the severity of TR. Small numbers limit the reliability of the observation of the excellent degree of correlation in severe TR. doi:10.1016/j.hlc.2011.05.372

Tricuspid valve surgery and intraoperative echocardiography: Factors affecting survival, clinical outcome, and echocardiographic success

Background. The impact of echocardiographic-guided treatment on outcome after tricuspid valve (TV) surgery is not well defined.Objectives. The purpose of this study was to determine clinical and echocardiographic factors associated with adverse outcomes after TV surgery and determine the role of intraoperative echo (IOE) in facilitating successful outcomes after TV surgery.Methods. Four hundred and one patients (279 females, mean age 60 years) underwent TV surgery and other concomitant cardiac surgery at a single institution and were followed clinically and by echocardiography during a 10-year period.Results. Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR] = 2.02), increased left ventricular dysfunction by echocardiography (RR = 1.28), and use of a TV replacement strategy (RR = 2.92). Decreased event-free survival after TV surgery was associated with concomitant coronary artery bypass grafting (RR = 2.97). Late echocardiographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR] = 1.91). Decreased late echocardiographic failure after TV surgery was associated with the use of a TV annuloplasty ring with a repair strategy (OR = 0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 (10%) of 335 patients based on IOE findings.Conclusions. Adverse outcomes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate, but not late, outcomes after TV surgery.