Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction.
Cardiac magnetic resonance imaging
Heart failure with preserved ejection fraction
Transcatheter tricuspid valve repair
Tricuspid regurgitation
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
11 Mar 2024
11 Mar 2024
Historique:
revised:
11
02
2024
received:
04
01
2024
accepted:
24
02
2024
medline:
11
3
2024
pubmed:
11
3
2024
entrez:
11
3
2024
Statut:
aheadofprint
Résumé
The aim of this study was to assess the pathophysiological implications of severe tricuspid regurgitation (TR) in patients with heart failure with preserved ejection fraction (HFpEF) by using tricuspid transcatheter edge-to-edge repair (T-TEER) as a model of right ventricular (RV) volume overload relief. This prospective interventional single arm trial (NCT04782908) included patients with invasively diagnosed HFpEF. The following parameters were prospectively assessed before and after T-TEER: left ventricular (LV) diastolic properties by invasive pressure-volume loop recordings; biventricular time-volume curves and function as well as septal curvature by cardiac magnetic resonance imaging; strain analyses for timing of septal motion. Overall, 20 patients (median age 78, interquartile range [IQR] 72-83 years, 65% female) were included. T-TEER reduced TR by a median of 2 (of 5) grades (IQR 2-1). T-TEER increased LV stroke volume and LV end-diastolic volume (LVEDV) (p < 0.001), without increasing LV end-diastolic pressure (LVEDP) (p = 0.094), consequently diastolic function improved with a reduction in LVEDP/LVEDV (p = 0.001) and a rightward shift of the end-diastolic pressure-volume relationship. The increase in LVEDV correlated with a decrease in RV end-diastolic volume (p < 0.001) and LV transmural pressure increased (p = 0.028). Secondary to a decrease in early RV filling, improvements in early LV filling were observed, correlating with an alleviation of leftwards bowing of the septum (p < 0.01, respectively). Diastolic LV properties in patients with HFpEF and severe TR are importantly determined by ventricular interaction in the setting of RV volume overload. T-TEER reduces RV volume overload and improves biventricular interaction and physiology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Deutsche Herzstiftung
ID : F06/20
Informations de copyright
© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
Adamo M, Chioncel O, Benson L, Shahim B, Crespo-Leiro MG, Anker SD, et al. Prevalence, clinical characteristics and outcomes of heart failure patients with or without isolated or combined mitral and tricuspid regurgitation: Insight from the ESC-HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail 2023;25:1061-1071. https://doi.org/10.1002/ejhf.2929
Santas E, Chorro FJ, Miñana G, Méndez J, Muñoz J, Escribano D, et al. Tricuspid regurgitation and mortality risk across left ventricular systolic function in acute heart failure. Circ J 2015;79:1526-1533. https://doi.org/10.1253/circj.CJ-15-0129
Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging 2014;7:1185-1194. https://doi.org/10.1016/j.jcmg.2014.07.018
Mascherbauer J, Kammerlander AA, Zotter-Tufaro C, Aschauer S, Duca F, Dalos D, et al. Presence of ‘isolated’ tricuspid regurgitation should prompt the suspicion of heart failure with preserved ejection fraction. PLoS One 2017;12:e0171542. https://doi.org/10.1371/journal.pone.0171542
Orban M, Rommel KP, Ho EC, Unterhuber M, Pozzoli A, Connelly KA, et al. Transcatheter edge-to-edge tricuspid repair for severe tricuspid regurgitation reduces hospitalizations for heart failure. JACC Heart Fail 2020;8:265-276. https://doi.org/10.1016/j.jchf.2019.12.006
Kresoja KP, Lauten A, Orban M, Rommel K-P, Alushi B, Besler C, et al. Transcatheter tricuspid valve repair in the setting of heart failure with preserved or reduced left ventricular ejection fraction. Eur J Heart Fail 2020;22:1817-1825. https://doi.org/10.1002/ejhf.1975
Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013;62:263-271. https://doi.org/10.1016/j.jacc.2013.02.092
Rommel KP, Besler C, Noack T, Blazek S, von Roeder M, Fengler K, et al. Physiological and clinical consequences of right ventricular volume overload reduction after transcatheter treatment for tricuspid regurgitation. JACC Cardiovasc Interv 2019;12:1423-1434. https://doi.org/10.1016/j.jcin.2019.02.042
Rosch S, Kresoja KP, Besler C, Fengler K, Schöber AR, von Roeder M, et al. Characteristics of heart failure with preserved ejection fraction across the range of left ventricular ejection fraction. Circulation 2022;146:506-518. https://doi.org/10.1161/CIRCULATIONAHA.122.059280
Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, et al. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024;26:18-33. https://doi.org/10.1002/ejhf.3106
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022;24:4-131. https://doi.org/10.1002/ejhf.2333
Kresoja KP, Rommel KP, Thiele H, Lurz P. Ventricular interaction in a patient with heart failure with preserved ejection fraction and severe tricuspid regurgitation. Circ Heart Fail 2021;14:e008768. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008768
Kresoja KP, Rommel KP, Lücke C, Unterhuber M, Besler C, von Roeder M, et al. Right ventricular contraction patterns in patients undergoing transcatheter tricuspid valve repair for severe tricuspid regurgitation. JACC Cardiovasc Interv 2021;14:1551-1561. https://doi.org/10.1016/j.jcin.2021.05.005
Lurz P, Puranik R, Nordmeyer J, Muthurangu V, Hansen MS, Schievano S, et al. Improvement in left ventricular filling properties after relief of right ventricle to pulmonary artery conduit obstruction: Contribution of septal motion and interventricular mechanical delay. Eur Heart J 2009;30:2266-2274. https://doi.org/10.1093/eurheartj/ehp258
Roeleveld RJ, Marcus JT, Faes TJC, Gan TJ, Boonstra A, Postmus PE, et al. Interventricular septal configuration at mr imaging and pulmonary arterial pressure in pulmonary hypertension. Radiology 2005;234:710-717. https://doi.org/10.1148/radiol.2343040151
Andersen MJ, Nishimura RA, Borlaug BA. The hemodynamic basis of exercise intolerance in tricuspid regurgitation. Circ Heart Fail 2014;7:911-917. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001575
Ren Q, Li X, Fang J, Chen Y, Wu MZ, Yu YJ, et al. The prevalence, predictors, and prognosis of tricuspid regurgitation in stage B and C heart failure with preserved ejection fraction. ESC Heart Fail 2020;7:4051-4060. https://doi.org/10.1002/ehf2.13014
Baratto C, Caravita S, Corbetta G, Soranna D, Zambon A, Dewachter C, et al. Impact of severe secondary tricuspid regurgitation on rest and exercise hemodynamics of patients with heart failure and a preserved left ventricular ejection fraction. Front Cardiovasc Med 2023;10:1061118. https://doi.org/10.3389/fcvm.2023.1061118
Moore TD, Frenneaux MP, Sas R, Atherton JJ, Morris-Thurgood JA, Smith ER, et al. Ventricular interaction and external constraint account for decreased stroke work during volume loading in CHF. Am J Physiol Heart Circ Physiol 2001;281:H2385-H2391. https://doi.org/10.1152/ajpheart.2001.281.6.H2385
Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res 2017;113:1474-1485. https://doi.org/10.1093/cvr/cvx160
Lurz P, Muthurangu V, Schuler PK, Giardini A, Schievano S, Nordmeyer J, et al. Impact of reduction in right ventricular pressure and/or volume overload by percutaneous pulmonary valve implantation on biventricular response to exercise: An exercise stress real-time CMR study. Eur Heart J 2012;33:2434-2441. https://doi.org/10.1093/eurheartj/ehs200
Belenkie I, Smith ER, Tyberg JV. Ventricular interaction: From bench to bedside. Ann Med 2001;33:236-241. https://doi.org/10.3109/07853890108998751
Laks MM, Garner D, Swan HJ. Volumes and compliances measured simultaneously in the right and left ventricles of the dog. Circ Res 1967;20:565-569. https://doi.org/10.1161/01.res.20.5.565
Summer WR, Permutt S, Sagawa K, Shoukas AA, Bromberger-Barnea B. Effects of spontaneous respiration on canine left ventricular function. Circ Res 1979;45:719-728. https://doi.org/10.1161/01.res.45.6.719
Caravita S, Iacovoni A, Senni M. The right side of the circulation in not secondary heart failure with preserved ejection fraction: An elephant in the room? Eur J Heart Fail 2021;23:1659-1661. https://doi.org/10.1002/ejhf.2294
Reddy YNV, Obokata M, Verbrugge FH, Lin G, Borlaug BA. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Am Coll Cardiol 2020;76:1051-1064. https://doi.org/10.1016/j.jacc.2020.07.009
Badano LP, Caravita S, Rella V, Guida V, Parati G, Muraru D. The added value of 3-dimensional echocardiography to understand the pathophysiology of functional tricuspid regurgitation. JACC Cardiovasc Imaging 2021;14:683-689. https://doi.org/10.1016/j.jcmg.2020.04.029
Sorajja P, Whisenant B, Hamid N, Naik H, Makkar R, Tadros P, et al.; TRILUMINATE Pivotal Investigators. Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med 2023;388:1833-1842. https://doi.org/10.1056/NEJMoa2300525