Epiphenomenon or prognostically relevant interventional target?

  • \(\bf BACKGROUND:\) Tricuspid regurgitation (TR) frequently develops in patients with long-standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. \(\textbf {METHODS AND RESULTS:}\) In this multicenter study, we included 533 patients undergoing TTVI for moderate-to-severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2-year all-cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio \(\leq\)1.25\(mm^{2}\)/mmHg (defining proportionate TR) featured significantly lower 2-year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; \(\it P\)=0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9\(\pm\)9.06mmHg versus 27.9\(\pm\)8.17mmHg; \(\it {P}<2.2×10^{−16}\)) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0\(\pm\)4.11 versus 17.0\(\pm\)4.64mm; \(\it P\)=0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350\(\pm\)0.105\(cm^{2}\) versus 0.770\(\pm\)0.432\(cm^{2}\); \(\it {P}<2.2×10^{−16}\)). Importantly, proportionate TR remained a significant predictor for 2-year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; \(\it P\)=0.006). \(\bf CONCLUSIONS:\) The proposed proportionality framework promises to improve future risk stratification and clinical decisionmaking by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.

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Author:Vera FortmeierORCiDGND, Mark LachmannORCiDGND, Matthias UnterhuberGND, Lukas StolzORCiDGND, Mohammad KassarORCiDGND, Laurin OchsORCiDGND, Muhammed GerçekORCiDGND, Anne R. SchöberGND, Thomas J. StockerORCiDGND, Hazem OmranORCiDGND, Maria Isabel KörberORCiDGND, Amelie HesseORCiDGND, Kai FriedrichsORCiDGND, Shinsuke YuasaORCiDGND, Tanja RudolphORCiDGND, Michael JonerORCiDGND, Roman PfisterORCiDGND, Stephan BaldusORCiDGND, Karl‐Ludwig LaugwitzORCiDGND, Fabien PrazGND, Stephan WindeckerORCiDGND, Jörg HausleiterORCiDGND, Philipp LurzORCiDGND, Volker RudolphORCiDGND
Parent Title (English):Journal of the American Heart Association
Subtitle (English):A novel proportionality framework for severe tricuspid regurgitation
Publisher:American Heart Association
Place of publication:Dallas, Texas
Document Type:Article
Date of Publication (online):2024/01/18
Date of first Publication:2023/03/16
Publishing Institution:Ruhr-Universität Bochum, Universitätsbibliothek
Tag:Open Access Fonds
pulmonary hypertension; transcatheter tricuspid valve intervention; tricuspid regurgitation
Issue:6, Article e028737
First Page:e028737-1
Last Page:e028737-29
Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum.
Institutes/Facilities:Herz- und Diabeteszentrum NRW
Herz- und Diabeteszentrum NRW, Klinik für Allgemeine und Interventionelle Kardiologie
Dewey Decimal Classification:Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit
open_access (DINI-Set):open_access
Licence (English):License LogoCreative Commons - CC BY-NC-ND 4.0 - Attribution-NonCommercial-NoDerivatives 4.0 International