Significant TR Research Articles

39 Overview of tricuspid regurgitation (tr). new classification of tr. when severe tr is too severe?

Abstract Introduction Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, it is not know how many of the patients classified as severe TR, corresponds to the new Torrential or massive classification that for sure will lead to different treatment strategies. Also few published studies have addressed the aetiologies, mechanisms and severity in large cohorts. Purpose To evaluate the burden of TR in a large cohort of patients referred for an echocardiography. Methods Prospective study where consecutive patients undergoing an echocardiographic study in 10 Spanish hospitals within a three-month period were included. All studies with at least moderate TR were selected for analysis. The evaluation was conduced according to the usual practice of the laboratory. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR was quantified according to Hanh & Zamorano new published classification. Results A total of 35088 consecutive echocardiographic studies were performed in the participant hospitals during the recruitment period. TR of at least moderate degree was detected in 2124 studies (6,05%). Mean age was 77,1 years and 62.8% were women. Mitral or aortic valvulopthy was the most common cause, present in almost half of cases (48.4%). The second cause of TR was idiopathic with 22.2% of cases. Primary TR was found in 7.2% of patients, the most frequent aetiology in these group was cardiac implantable devices with 4.2% of total of TR. Aetiology and severity according to the new classification can be seen in the figures Atrial fibrillation was present in 47.6% of cases. 56.4% of patients had symptoms at the time of the study (NYHA≥2 at the time of study). Right ventricle (RV) was dilated (telediastolic basal diameter >42mm) in 39.4% of patients). RV function was impared (TAPSE <17mm) in 30.6% of patients. Conclusions In these larger multicentre study, significant TR may is present in up to 6% of the echocardiographic studies and is often symptomatic[m1] . 4,91% of patients had a massive or torrential grade. Most TR are secondary to mitral or aortic valvulopathy. Idiopathic TR has taken the second place. Abstract 39 Figure. Severity and aetiology of TR

Intracardiac echocardiography to enable successful edge-to-edge transcatheter tricuspid valve repair in patients with insufficient TEE quality.

Transesophageal echocardiography (TEE) as a guiding tool for edge-to-edge transcatheter tricuspid valve repair (EETVr) using MitraClip (Abbott Vascular, Santa Clara, USA) may not offer sufficient image quality in a significant proportion of patients. Intracardiac echocardiography (ICE) as additional guiding tool in EETVr with the MitraClip device. Appropriate angulations of the ICE catheter to visualize each commissure of the tricuspid valve were established in 3D printed heart models. In a single tertiary-care center ICE was used to support EETVr as additional guidance when TEE image quality was insufficient. Procedural safety and outcomes up to 30-days were compared between ICE/TEE and TEE only guided patients. In 6 of 11 patients (54.5%) undergoing EETVr with MitraClip TEE alone was unsatisfactory, necessitating additional ICE guidance. In 4 of these 6 patients ICE enabled a successful completion of the procedure. The steering maneuvers identified in the 3D models were well applicable in all patients, providing examples for potential future ICE implementation in EETVr. Under both TEE alone (n = 5) and ICE (n = 6) guidance the rate of procedural complications was 0%. According to vena contracta values at discharge significant TR reduction was achievable in the treated cohort (p = 0.011). At 30-days follow-up one patient (ICE guided) died following global heart failure, not associated with the procedure itself. ICE guidance may offer an additional tool to guide EETVr with the MitraClip device in patients with poor TEE quality, as it enables successful results without impairing procedural safety.

Right sided heart evaluation after successful mitral valve replacement.

Introduction: It is well-documented that right-sided heart dysfunction and significant tricuspid valve regurgitation (TVR) have adverse effects on patient outcomes after left-sided heart valve surgery. Therefore, the evaluation of right ventriclular (RV) function and TR severity in patients who had undergone mitral valve replacement (MVR), associated with/without concomitant surgery on tricuspid valve, could be helpful for deciding on the necessity of concomitant tricuspid valve intervention before surgery. Materials and Methods: A total of222 patients with MVR for rheumatic disease were evaluated in our Echocardiography Lab in Ghaem Hospital, Mashhad, Iran, within 2013-2018. The patients were divided into four groups, according to their type of concomitant TVR. The subjects (n=11) with concomitant indications for coronary artery bypass grafting (CABG) or history of coronary artery disease were excluded from the study. Results: Significant (at least moderate) TVR was found in 60% of the patients. All patients with rheumatic tricuspid valve had significant TVR. After excluding the patients with significant pulmonary hypertension, there was no difference in the prevalence of significant TR, between the patients with tricuspid valve repair and those without any intervention on tricuspid valve (P=0.178). Furthermore, no difference was observed between the patients with/without any intervention on tricuspid valve considering RV size and function. Conclusion: In patients with left valve surgery concomitant with TR, tricuspid valve repair and replacement could preserve RV size and function, for a long time. During the correction of the left-side valvulopathy, it seems rational to adopt more interventional consideration for patients with tricuspid valve regurgitation, especially those with rheumatic tricuspid valve involvement.

P1783Prognostic implications of significant tricuspid regurgitation in patients with atrial fibrillation in the absence of left-sided heart disease or pulmonary hypertension

Abstract Background Tricuspid regurgitation (TR) can be caused by atrial fibrillation (AF) in the absence of left-sided heart disease or pulmonary hypertension. The prognostic impact of AF-TR has not been investigated. Purpose The aim of this study was to investigate the prognostic significance of TR in AF patients who do not show left-sided heart disease, pulmonary hypertension or primary structural abnormalities. Methods A total of 63 AF patients with moderate and severe TR were identified and matched by age and gender to 116 patients with AF without significant TR, resulting in a total study population of 179 patients (mean age 71±7 years, 59% male). As per design of the study, patients with primary TR, significant (moderate or severe) aortic and/or mitral valve disease, previous valvular surgery, congenital heart disease, left ventricular ejection fraction <50%, systolic pulmonary artery pressure >40mmHg, pacemaker or implantable cardioverter defibrillator leads in situ were excluded as well as patients with AF de novo. Patients were followed for the combined endpoint of all-cause mortality, hospitalization for heart failure and stroke. Results Patients with AF-TR had more often paroxysmal AF as compared to patients without TR (60% vs. 43%, p=0.028). In addition, right atrial volumes and the tricuspid annulus diameter (TAD) were significantly larger in patients with AF-TR compared to their counterparts (p<0.001 for all). Furthermore, tricuspid annular plane systolic excursion was significantly lower in patients with AF-TR (17±5 mm vs. 21±6 mm, p<0.001). During follow-up (median 62 [32–95] months) 55 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with TR were 71% and 53%, compared to 92% and 85% for patients without TR, respectively (Log rank Chi-Square p<0.001; Figure). In the multivariable Cox proportional hazard model adjusted for age, gender, NYHA functional class >2, renal function, right ventricular (RV) function and TAD, the presence of significant TR was independently associated with the combined endpoint (HR, 2.495; 95% CI, 1.167–5.335; p=0.018), while RV function was not (HR, 1.026; 95% CI, 0.971–1.085; p=0.364). Figure 1. Kaplan-Meier curves Conclusion In the absence of left-sided heart disease and pulmonary hypertension, significant TR is independently associated with worse event-free survival in patients with AF.

Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review.

Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.

A simple measure of the extent of Ebstein valve rotation with cardiovascular magnetic resonance gives a practical guide to feasibility of surgical cone reconstruction

BackgroundOnce surgical management is indicated, variation of Ebstein valve morphology affects surgical strategy. This study explored practical, easily measureable, cardiovascular magnetic resonance (CMR)-derived attributes that may contribute to the complexity and risk of cone reconstruction.MethodsA retrospective assessment was performed of Ebstein anomaly patients older than 12 years age, with pre-operative CMR, undergoing cone surgical reconstruction by one surgeon. In addition to clinical data, the CMR-derived Ebstein valve rotation angle (EVRA), area ratios of chamber size, indexed functional RV (RVEDVi) and left ventricular (LV) volumes, tricuspid valve regurgitant fraction (TR%) and other valve attributes were related to early surgical outcome; including death, significant residual TR% or breakdown of repair.ResultsOf 26 operated patients older than 12 years age, since program start, 20 had pre-op CMR and underwent surgery at median (range) age 20 (14–57) years. TR% was improved in all patients. Four of the 20 CMR patients (20%) experienced early surgical dehiscence of the paravalve tissue, with cone-shaped tricuspid valve intact; one of whom died.A larger EVRA correlated with Carpentier category and was significantly related to dehiscence. If EVRA >60o, relative risk of dehiscence was 3.2 (CI 1.3–4.9, p = 0.03). Those with dehiscence had thickened, more tethered anterior leaflet edges (RR 17, CI 3–100, p < 0.01), smaller pre-operative functional RVEDVi; (132 vs 177 mL/m2, p = 0.04), and were older (median 38 vs 19 years, p = 0.01). TR %, chamber area ratios and LV parameters were not different.ConclusionsComprehensive CMR assessment characterizes patients prior to cone surgical reconstruction of Ebstein anomaly. Pragmatic observation of larger EVRA, smaller RVEDVi and leaflet thickening, suggests risk of repair tension and dehiscence, and may require specific modification of cone surgical technique, such as leaflet augmentation.

Trend and Abrupt Regime Shift of Temperature Extreme in Northeast China, 1957–2015

Trend and an abrupt regime shift of temperature extremes were investigated based on diurnal data at 116 meteorological stations in the Northeast China region during 1957–2015. A total of 10 temperature indices divided into two categories: extremely cold and warm indices, were used in this study. The Mann–Kendall (MK) test was employed to evaluate the trend in temperature while changepoint, an R package for changepoint analysis, was used to detect changes in the mean levels of temperature extreme data series. The results of this study reveal that occurrence frequencies of the extreme cold night (TN10p) and extreme warm night (TN90p) have decreased and increased by −1.67 and 1.79 days/decade, respectively. Moreover, variations in temperature extremes have not been uniform with warming trends in minimum temperature being rapidly compared to maximum temperature extremes. The diurnal temperature range (DTR) depicted a remarkable decrease as a result of rapid warming in the minimum temperature. Warming in the region led to a reduction in the number of frost days (FD) and icing days (ID) and an increase in the number of growing season length (GSL) and tropical nights (Tr). Seasonally, TN10p largely decreased in winter and spring, while TNn and TN90p largely increased in winter and summer, respectively. Spatially, most of the stations with a significant warming trend in minimum temperatures were located in the Changbai Mountain, Greater Khingan Range, and Lesser Khingan Range. This implies that the mountainous regions are more sensitive and vulnerable to warming than the plain regions. On the contrary, most stations located in the Songnen Plain, Sanjiang Plain, and Liao River Plain displayed significant positive trend GSL and Tr. These climate extreme trends show that the region is experiencing warming which may have an impact on the hydrological process, ecological process, and agricultural production capacity.

A comparative analysis between ring annuloplasty and de vega annuloplasty in functional tricuspid regurgitation

Background: Tricuspid valve disease frequently accompanies left side valve disease. Surgical correction of significant functional TR at the time of left side valve surgery is recommended. The current study was under taken to assess the early impact of ring annuloplasty and De Vega annuloplasty techniques in functional significant TR in a predominantly rheumatic population.Methods: Between January 2010 and January 2014, a total 80 patients underwent surgery for functional tricuspid valve disease. Retrospective data analysis was done. The patient selection criteria were as per the institutional protocol (for all functional severe TR and moderate TR with Tricuspid Index &gt; 21mm/m2) based on preoperative TTE (Trans-thoracic Echocardiography) findings and the type of procedure was the surgeon’s decision on table. Techniques routinely involved in the repair procedures included tricuspid prosthetic ring Annuloplasty (MC3) and De Vega suture annuloplasty. Postoperatively all the patient had routine TTE before hospital discharge (considered as immediate post op period). Follow up was present till 6 months post-operatively (in the form of another TTE and clinical data sheet) at the time of data collection for this study. Results: There was no statistically significant difference in residual significant TR when ring annuloplasty was compared to De Vega repair. There was significant improvement in NYHA status after both ring and De Vega annuloplasty. Conclusions: Present study shows similar results with both the techniques of TV repair when applied to functionally significant TR in a pre-dominantly rheumatic population.

Large animal model of acute right ventricular failure with functional tricuspid regurgitation

BackgroundFunctional tricuspid regurgitation (FTR) commonly arises secondary to conditions affecting the left heart and is associated with right ventricular dysfunction and tricuspid annular dilatation. We set out to establish an animal model of acute RV failure (RVF) with FTR resembling the clinical features. MethodsTen adult sheep had pressure sensors placed in the LV, RV, and right atrium while sonomicrometry crystals were implanted around tricuspid annulus and on the RV. Animals were studied open-chest to assess for RV function and FTR after: (1) volume infusion, (2) pulmonary artery constriction, (3) 5 min posterior descending artery occlusion, and (4) combination of all interventions. Hemodynamic, echocardiographic, and sonomicrometry data were collected at baseline and after every intervention. RV dimensions, RV strain, and annular area, perimeter, and size were calculated from crystal coordinates. The model was validated in six additional sheep studied only before and after combined interventions. ResultsNeither volume infusion, pulmonary hypertension, nor ischemia were associated with RVF or clinically significant TR when applied separately but combined resulted in RVF and greater than moderate FTR. In the validation group, maximal RV volume increased (62 ± 14 vs 70 ± 16 ml, p = 0.006), contractility decreased (20 ± 6 vs 12 ± 2%, p = 0.02), and strain increased. FTR increased from 0.4 ± 0.5 to 2.5 ± 0.8 (p < 0.001) and annular area from 652 ± 87 mm2 to 739 ± 87 mm2 (p = 0.005). ConclusionsThe developed ovine model of acute RVF was associated with significant annular and RV enlargement and FTR. This novel and clinically pertinent research platform offers insight into the acute RVF pathophysiology and can be utilized to evaluate treatment interventions.

S171. ALTERED WHITE MATTER CONNECTIVITY IN PATIENTS WITH SCHIZOPHRENIA USING PUBLIC NEUROIMAGING DATA FROM SCHIZCONNECT

BackgroundSeveral studies have produced a large body of evidence for white matter abnormalities related to schizophrenia. The literature has yet to achieve a state of consistency and reproducibility, and reported low integrity of white matter tracts vary between studies. Whole brain image study with large sample size is needed to address this issue. We investigated white matter integrity in connections between regions of interests (ROI) in the same hemisphere in patients with schizophrenia and healthy controls with public neuroimaging data from SchizConnect (http://schizconnect.org).MethodsA final data set was consisted of 129 healthy controls and 122 schizophrenia patients. For each diffusion weighted image (DWI), a two-tensor full-brain tractography was performed, and DWI images were parcellated by processing and registering the T1 images with FreeSurfer and the Advanced Normalization Tools. We extracted a total of 36 tracts in the both hemisphere connecting ROIs in the same hemisphere with white matter query language. We compared means of diffusion measures between patients and controls, and evaluated correlations with Letter-number sequencing (LNS) test, Vocabulary test, letter fluency test, category fluency test, and trails A of the Trail Making Test (TMT). The Benjamini-Hochberg procedure with false discovery rate (FDR) of 0.05 was used to correct for multiple comparisons.ResultsWe found a significant RD and TR increase of the left thalamo-occipital tracts and the right uncinate fascicle (UF), and a significant RD increase of the right middle longitudinal fascicle (MDLF), and the right superior longitudinal fascicle (SLF) ii in schizophrenia. There were correlations between the TR in the left thalamo-occipital tracts and letter fluency test, and the RD in the right SLF ii and LNS test, which did not survive after correction for multiple comparisons.DiscussionThese results indicate widespread abnormalities of white matter fiber tracts in schizophrenia, contributing to the pathophysiology of schizophrenia.

Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: importance of pre-operative tricuspid annulus diameter.

Secondary tricuspid regurgitation (STR) is commonly found in patients with aortic stenosis and is associated with increased morbidity. The study sought to evaluate the prevalence of pre-operative STR and its progression after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Also, it sought to analyse the predictors of post-operative changes in STR. We prospectively evaluated 116 patients (aged 75.1 ± 9.8 years, predominantly male) who undergo SAVR or TAVI for severe aortic stenosis (AS) from September 2013 to April 2015. Patients with associated valve disease requiring intervention, significant coronary artery disease or left ventricular ejection fraction (LVEF) <50% were excluded. Clinical and echocardiographic data, including TR grade and right ventricular (RV) size and function, were assessed at baseline and at the 1-year follow-up. At baseline, significant TR was documented in 13 patients (11.1%) and non-significant TR was documented in 103 patients (88.9%). Atrial fibrillation (AF) was more prevalent in patients with a tricuspid annulus diameter ≥40 mm (P < 0.0051). At the 1-year follow-up, the TR grade had improved in 17 patients (14.7%), was unchanged in 68 patients (58.6%) and had worsened in 31 patients (26.7%). Moderate to severe TR was found in 30 patients (25.8%). Tricuspid annulus diameter >40 mm was the only echocardiographic predictor of significant postoperative TR (relative risk (RR) = 2.12 [1.26-3.54], P = 0.004). Right heart function and size were not independent predictors. Significant TR was present pre-operatively in 11.1% of patients. Post-operative progression was observed in 26.7% of patients. Only tricuspid annulus size >40 mm was an independent echocardiographic predictor of moderate to severe TR at the 1-year follow-up.

Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation in Patients With Right Ventricular Volume/Pressure Overload

BackgroundTricuspid regurgitation (TR) is a common and important comorbidity in patients with postoperative right ventricular outflow tract (RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter pulmonary valve replacement (TPVR) has become a useful tool in the management of postoperative RVOT obstruction and PR, but it is unknown whether relief of the right ventricular volume and/or pressure overload by TPVR will have a beneficial effect on TR, as is often seen with surgical pulmonary valve replacement. ObjectivesThis study sought to assess the prevalence of and factors associated with significant TR in patients undergoing TPVR for RVOT obstruction or PR. MethodsData were combined from 3 prospective multicenter trials of patients referred for TPVR. Follow-up data through 5 years post-implantation were analyzed. ResultsOf 300 patients studied, 77 (25.6%) had moderate or severe TR at baseline. After TPVR, TR severity was improved in 65% of those patients, and more than one-half had mild TR or less TR at discharge. Of 13 patients with severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and beyond. Moderate or severe baseline TR was associated with shorter freedom from RVOT reintervention after TPVR. ConclusionsIn this prospective multicenter study of post-operative patients with RVOT obstruction and/or PR, TR was common. In patients with significant baseline TR, TPVR resulted in clinically relevant acute reductions in TR that persisted over at least 5 years of follow-up. These observations support the application of TPVR therapy in patients with RVOT obstruction or PR who are anatomically suitable, even in the setting of significant concomitant TR.

Abstract 11011: Long-Term Outcomes of Definitive Surgical Repair for Congenitally Corrected Transposition of the Great Arteries

Background: Congenitally corrected transposition of the great arteries (ccTGA) is characterized by atrioventricular and ventriculoarterial discordance. The indications, timing, and type of repair vary according to the morphology of the heart, the clinical status of the patient, and the patient’s age. Optimal surgical management of patients with ccTGA remains controversial. Methods: The medical records of all patients with ccTGA who underwent definitive repairs between 1977 and 2013 were retrospectively reviewed. The surgical procedures comprised a physiologic repair in 45 patients, anatomic repair (double switch operation) in 14 patients, and a Fontan-type repair in 12 patients. Results: The Kaplan-Meier survival at 20 years was similar (75.7% in physiologic repair vs. 83.3% in anatomic repair). However, patients with significant TR showed a worse survival rate than those of the other groups (20 year survival without TVR 96.3%, but only 58.6% with TVR). The freedom from reoperation at 10 years was 78.3% in physiologic repair vs. 66.7% in anatomic repair. The freedom from pacemaker implantation at 10 years was 93.0% in physiologic repair vs. 64.3% in anatomic repair. 14 patients underwent a Fontan-type repair without mortality or heart block. Conclusions: No differences were observed between long-term survival rates of patients who underwent physiologic versus anatomic repair. The poorest outcome was seen in patients who required tricuspid valve replacement. Performing an anatomic repair should be considered for patients with significant TR. The best outcome was seen in the patients undergoing the Fontan procedure. However, various complications late after Fontan procedure remain a concern.

(646) - Prevalence of Late Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation

s S239 TVR had higher rates of RVF even when grouped according to TA dilation status (log-rank p< 0.0001). In-hospital mortality did not differ according to TA/TR or TVR status. Conclusion: TA dilation seems to be a stronger predictor of RVF post LVAD implant than significant TR. The potential benefit of concomitant TVR in selected patients submitted to LVAD implant remains to be determined.

(644) - RV Fractional Area Change at 6 Months But Not at Pre-Implant Is Associated with Late Indices of Functional Capacity and Renal Function: A Case for the Importance of Late RV Dysfunction in Long Term MCS

s S239 TVR had higher rates of RVF even when grouped according to TA dilation status (log-rank p< 0.0001). In-hospital mortality did not differ according to TA/TR or TVR status. Conclusion: TA dilation seems to be a stronger predictor of RVF post LVAD implant than significant TR. The potential benefit of concomitant TVR in selected patients submitted to LVAD implant remains to be determined.

TCT-793 Effects of Preoperative Tricuspid Regurgitation on Mitral Regurgitation Treatment with the MitraClip Device in High-Risk Patients

Background: Purpose of the study is to characterize high-risk patients with mitral regurgitation (MR) treated with the MitraClip device (Abbott Vascular, Abbott Park, Illinois) and to assess the impact of preoperative TR 3 on the outcomes at mid-term follow-up after MitraClip treatment. Methods: From November 2008 to March 2012, 106 consecutive patients with degenerative and functional moderate to severe or severe MR underwent MitraClip implantation at our institution. All the patients were assessed by a preoperative standardized protocol, which included TEE , angiography and evaluation of the surgical risk. The functional status was assessed by 6MWT, while quality of life was evaluated by MLHFQ and SF-36 questionnaires. Short and mid-term outcomes of patients with and without concomitant TR 3 (TR group and no-TR group, respectively) were compared. Results: Preoperative TR 3 was present in 21/106 patients (19.8%). Patients of the 2 groups were similar for age, comorbidities and surgical risk. Functional etiology was present in 71.4% of the TR group and in 70.6% of the no-TR group (p 0.9). Preoperative echocardiography showed similar LVEDD (p 0.5) and LVEF (p 0.4). Patients of the TR group had worse quality of life (MLHFQ 44.7 Vs 36.9p 0.04; SF-36 physical domain 30.4 Vs 36.6 –p 0.004). In-hospital mortality was 0% in TR group and 1.2% in no-TR group (p 0.6). Similar reduction of MR to 2 before discharge was achieved in the 2 groups (TR group 90.5%, no-TR group 91.6%, p 0.8). At 1 year follow-up, actuarial survival was 79.4 10.6% for TR group and 91.1 3.9% for no-TR group (p 0.5) while freedom from MR 3 was 67.7 12.1% for TR group and 85.1 5.1% for no-TR group (p 0.04). At last follow-up (mean 9.2 months, range 1-41 months), overall freedom from death, MR 3 and rehospitalization for HF was 47.6% for TR group and 69% for no-TR group (p 0.06). The presence of preoperative TR 3 was identified as predictor of recurrence of MR 3 (OR 3.75). Conclusions: TR is associated with more impaired QoL in MitraClip candidates. Moreover, in patients with significant TR, the recurrence of MR 3 and the incidence of death, MR recurrence and rehospitalization for HF result higher at mid-term follow-up. TCT-794

Late Pulmonary Valve Replacement in Patients With Pulmonary Atresia and Intact Ventricular Septum: A Case-Matched Study

Pulmonary valve replacement (PVR) is a common therapy for chronic pulmonary regurgitation. However, the use of this strategy is mostly based on the studies performed on patients with tetralogy of Fallot (TOF) and not in patients with pulmonary atresia/intact ventricular septum (PA/IVS). The aim of this study is to evaluate our experience with PVR in patients with PA/IVS and compare them with a matched cohort of TOF patients. Between 1995 and 2009, 13 patients with PA/IVS underwent a late PVR. Matched TOF control subjects were identified for 12 of these patients. Before and after PVR echocardiographic, magnetic resonance imaging, exercise test, Holter, and electrocardiographic data were compared between groups. There was no mortality in either group. The PVR improved pulmonary regurgitant fraction and right ventricular volumes in all patients. Patients with PA/IVS had more significant tricuspid regurgitation (TR [at least moderate]) by echocardiography and magnetic resonance imaging before PVR (n = 11 [85%] versus n = 1 [8%]; p = 0.003) and had more tricuspid valve repairs than TOF patients (n = 9 [69%] versus n = 1 [8%]; p = 0.004). Repair was undertaken by a combination of techniques. Although TR was improved early postoperatively, only 2 of 9 patients (22%) were free from significant TR at most recent follow-up (median 2.5 years; range, 0.1 to 10.9). No patient underwent reoperation at latest follow-up. Patients with PA/IVS can undergo a late PVR with excellent results. Significant TR and repair are more commonly observed among patients with PA/IVS compared with TOF patients. Although tricuspid valve repair improves regurgitation early, TR tends to recur, suggesting the need for further refinement of current surgical techniques.

Significant Tricuspid Regurgitation Predicts Mortality in Patients Hospitalized With Acutely Decompensated Heart Failure

Background: Valvular disease can complicate management and clinical course in acutely decompensated heart failure (ADHF). The aim of the present study was to characterize the clinical and echocardiographic characteristics and short-term outcomes of hospitalized ADHF patients with and without significant TR and to determine whether significant TR is predictive of hospital length of stay (LOS) and 6- and 12-month outcomes. Methods: We retrospectively studied 167 patients hospitalized with ADHF at a tertiary teaching hospital.

Basal and Ethanol-Induced Cardiac Contractile Response in Lean and Obese Zucker Rat Hearts

Obesity plays a pivotal role in metabolic and cardiovascular diseases. Certain types of obesity may be related to alcohol ingestion, which itself leads to impaired cardiac function. This study analyzed basal and ethanol-induced cardiac contractile response using left-ventricular papillary muscles and myocytes from lean and obese Zucker rats. Contractile properties analyzed include: peak tension development (PTD), peak shortening amplitude (PS), time to PTD/PS (TPT/TPS), time to 90% relaxation/relengthening (RT₉₀/TR₉₀) and maximal velocities of contraction/shortening and relaxation/relengthening (±VT and ±dL/dt). Intracellular Ca²⁺ transients were measured as fura-2 fluorescence intensity (ΔFFI) changes and fluorescence decay time (FDT). In papillary muscles from obese rats, the baseline TPT and RT₉₀ were significantly prolonged accompanied with low to normal PTD and ±VT compared to those in lean rats. Muscles from obese hearts also exhibited reduced responsiveness to postrest potentiation, increase in extracellular Ca²⁺ concentration, and norepinephrine. By contrast, in isolated myocytes, obesity reduced PS associated with a significant prolonged TR₉₀, normal TPS and ±dL/dt. Intracellular Ca²⁺ recording revealed decreased resting Ca²⁺ levels and prolonged FDT. Acute ethanol exposure (80–640 mg/dl) caused comparable concentration-dependent inhibitions of PTD/PS and ΔFFI, associated with reduced ±VT in both groups. Collectively, these results suggest altered cardiac contractile function and unchanged ethanol-induced depression in obesity.

Basal and ethanol-induced cardiac contractile response in lean and obese Zucker rat hearts.

Obesity plays a pivotal role in metabolic and cardiovascular diseases. Certain types of obesity may be related to alcohol ingestion, which itself leads to impaired cardiac function. This study analyzed basal and ethanol-induced cardiac contractile response using left-ventricular papillary muscles and myocytes from lean and obese Zucker rats. Contractile properties analyzed include: peak tension development (PTD), peak shortening amplitude (PS), time to PTD/PS (TPT/TPS), time to 90% relaxation/relengthening (RT(90)/TR(90)) and maximal velocities of contraction/shortening and relaxation/relengthening (+/-VT and +/-dL/dt). Intracellular Ca(2+) transients were measured as fura-2 fluorescence intensity (DeltaFFI) changes and fluorescence decay time (FDT). In papillary muscles from obese rats, the baseline TPT and RT(90) were significantly prolonged accompanied with low to normal PTD and +/-VT compared to those in lean rats. Muscles from obese hearts also exhibited reduced responsiveness to postrest potentiation, increase in extracellular Ca(2+) concentration, and norepinephrine. By contrast, in isolated myocytes, obesity reduced PS associated with a significant prolonged TR(90), normal TPS and +/-dL/dt. Intracellular Ca(2+) recording revealed decreased resting Ca(2+) levels and prolonged FDT. Acute ethanol exposure (80-640 mg/dl) caused comparable concentration-dependent inhibitions of PTD/PS and DeltaFFI, associated with reduced +/-VT in both groups. Collectively, these results suggest altered cardiac contractile function and unchanged ethanol-induced depression in obesity.