Right Heart Remodeling and Outcomes in Patients With Tricuspid Regurgitation: A Literature Review and Meta-Analysis.

echocardiography functional tricuspid regurgitation right ventricle survival tricuspid valve

Journal

JACC. Cardiovascular imaging
ISSN: 1876-7591
Titre abrégé: JACC Cardiovasc Imaging
Pays: United States
ID NLM: 101467978

Informations de publication

Date de publication:
12 Feb 2024
Historique:
received: 25 05 2023
revised: 13 11 2023
accepted: 22 12 2023
medline: 2 3 2024
pubmed: 2 3 2024
entrez: 2 3 2024
Statut: aheadofprint

Résumé

Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR). This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+). MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements. Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, -6.3% [95% CI: -11.1% to -1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, -4.4% [95% CI: -5.9% to -2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, -4.1% [95% CI: -7.6% to -0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, -1.9% [95% CI: -2.5% to -1.3%]; P < 0.001) and mortality. RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).

Sections du résumé

BACKGROUND BACKGROUND
Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR).
OBJECTIVES OBJECTIVE
This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+).
METHODS METHODS
MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements.
RESULTS RESULTS
Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, -6.3% [95% CI: -11.1% to -1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, -4.4% [95% CI: -5.9% to -2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, -4.1% [95% CI: -7.6% to -0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, -1.9% [95% CI: -2.5% to -1.3%]; P < 0.001) and mortality.
CONCLUSIONS CONCLUSIONS
RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).

Identifiants

DOI: 10.1016/j.jcmg.2023.12.011 PMID: 38430099
pubmed: 38430099
pii: S1936-878X(24)00032-9
doi: 10.1016/j.jcmg.2023.12.011
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr von Roeder has received an institutional research grant from Deutsche Stiftung für Herzforschung. Dr Grayburn has received grant support from Abbott Vascular, Boston Scientific, 4C Medical, Edwards Lifesciences, Medtronic, Restore Medical, and W.L. Gore; and has received consulting fees/honoraria from Abbott Vascular, 4C Medical, Edwards Lifesciences, Medtronic, and W.L. Gore. Dr Sannino has received grant support from Cardiovalve and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Auteurs

Sara Bombace (S)

Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: https://twitter.com/sarabombace.

Federico Fortuni (F)

Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy. Electronic address: https://twitter.com/FedeFortuni9.

Giacomo Viggiani (G)

Department of Internal Medicine I, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.

Maria Chiara Meucci (MC)

Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Gianluigi Condorelli (G)

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy.

Erberto Carluccio (E)

Cardiology and Cardiovascular Pathophysiology, University of Perugia, Perugia, Italy.

Maximilian von Roeder (M)

Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.

Alexander Jobs (A)

Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.

Holger Thiele (H)

Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Science, Leipzig, Germany.

Giovanni Esposito (G)

Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.

Philipp Lurz (P)

Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

Paul A Grayburn (PA)

Baylor Scott and White Research Institute, Plano, Texas, USA.

Anna Sannino (A)

Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Baylor Scott and White Research Institute, Plano, Texas, USA; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany. Electronic address: anna.sannino@unina.it.

Classifications MeSH