Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair

被引：119

作者：

Brener, Michael, I ^{[1
]}

Lurz, Philipp ^{[2
]}

Hausleiter, Jorg ^{[3
]}

Rodes-Cabau, Josep ^{[4
]}

Fam, Neil ^{[5
]}

Kodali, Susheel K. ^{[1
]}

Rommel, Karl-Philipp ^{[2
]}

Muntane-Carol, Guillem ^{[4
]}

Gavazzoni, Mara ^{[6
]}

Nazif, Tamim M. ^{[1
]}

Pozzoli, Alberto ^{[7
]}

Alessandrini, Hannes ^{[8
]}

Latib, Azeem ^{[9
]}

Biasco, Luigi ^{[10
]}

Braun, Daniel ^{[3
]}

Brochet, Eric ^{[11
]}

Denti, Paolo ^{[12
,13
]}

Lubos, Edith ^{[14
]}

Ludwig, Sebastian ^{[14
]}

Kalbacher, Daniel ^{[14
]}

Estevez-Loureiro, Rodrigo ^{[15
]}

Connelly, Kim A. ^{[5
]}

Frerker, Christian ^{[16
]}

Ho, Edwin C. ^{[9
]}

Juliard, Jean-Michel ^{[11
]}

Harr, Claudia ^{[8
]}

Monivas, Vanessa ^{[17
]}

Nickenig, Georg ^{[18
]}

Pedrazzini, Giovanni ^{[10
]}

Philippon, Francois ^{[4
]}

Praz, Fabien ^{[19
]}

Puri, Rishi ^{[20
]}

Schofer, Joachim ^{[8
]}

Sievert, Horst ^{[21
]}

Tang, Gilbert H. L. ^{[22
]}

Andreas, Martin ^{[23
]}

Thiele, Holger ^{[2
]}

Unterhuber, Matthias ^{[2
]}

Himbert, Dominique ^{[11
]}

Alcazar, Marina Urena ^{[11
]}

Von Bardeleben, Ralph Stephan ^{[24
]}

Windecker, Stephan ^{[19
]}

Wild, Mirjam G. ^{[19
]}

Maisano, Francesco ^{[12
,13
]}

Leon, Martin B. ^{[1
]}

Taramasso, Maurizio ^{[6
]}

Hahn, Rebecca T. ^{[1
]}

机构：

[1] Columbia Univ, Div Cardiol, Med Ctr, NewYork Presbyterian Hosp, Herbert Irving Pavil,161 Ft Washington Ave, New York, NY 10032 USA

[2] Univ Leipzig, Heart Ctr Leipzig, Leipzig, Germany

[3] Univ Hosp Munich, Med Clin & Polyclin 1, Munich, Germany

[4] Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[5] St Michaels Hosp, Div Cardiol, Toronto Heart Ctr, Toronto, ON, Canada

[6] Heart Ctr Hirslanden Zurich, Zurich, Switzerland

[7] Cardioctr Ticino Inst, Div Cardiac Surg, Lugano, Switzerland

[8] Asklepios Clin St Georg, Hamburg, Germany

[9] Montefiore Med Ctr, Div Cardiol, New York, NY USA

[10] Univ Italian Switzerland, Dept Biomed Sci, Lugano, Switzerland

[11] Hop Xavier Bichat, Div Cardiol, Paris, France

[12] San Raffaele Univ Hosp, Div Cardiol, Milan, Italy

[13] San Raffaele Univ Hosp, Dept Cardiac Surg, Milan, Italy

[14] Univ Heart & Vasc Ctr, Dept Cardiol, Hamburg, Germany

[15] Univ Hosp Alvaro Cunqueiro, Intervent Cardiol Clin, Vigo, Spain

[16] Schleswig Holstein Univ, Univ Heart Ctr, Lubeck, Germany

[17] Puerta de Hierro Univ Hosp, Div Cardiol, Madrid, Spain

[18] Bonn Univ Hosp, Div Cardiol, Bonn, Germany

[19] Bern Univ Hosp, Div Cardiol, Inselspital, Bern, Switzerland

[20] Cleveland Clin Fdn, Dept Cardiovasc Med, Cleveland, OH USA

[21] Cardiovasc Ctr Frankfurt, Div Cardiol, Frankfurt, Germany

[22] Mt Sinai Hlth Syst, Dept Cardiovasc Surg, New York, NY USA

[23] Med Univ Vienna, Dept Cardiac Surg, Vienna, Austria

[24] Univ Med Ctr, Div Cardiol, Mainz, Germany

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2022年 / 79卷 / 05期

关键词：

transcatheter tricuspid valve repair; transcatheter tricuspid valve replacement; tricuspid regurgitation; ventricular-vascular coupling; right ventricle; NATIVE VALVULAR REGURGITATION; PLANE SYSTOLIC EXCURSION; HEART-FAILURE; ECHOCARDIOGRAPHIC-ASSESSMENT; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; RECOMMENDATIONS; DYSFUNCTION; IMPACT;

D O I：

10.1016/j.jacc.2021.11.031

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The right ventricular (RV)-pulmonary arterial (PA) coupling ratio relates the efficiency with which RV stroke work is transferred into the PA. Lower ratios indicate an inadequate RV contractile response to increased afterload. OBJECTIVES This study sought to evaluate the prognostic significance of RV-PA coupling in patients with tricuspid regurgitation (TR) who were undergoing transcatheter tricuspid valve repair or replacement (TTVR). METHODS The study investigators calculated RV-PA coupling ratios for patients enrolled in the global TriValve registry by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) from transthoracic echocardiograms performed before the procedure and 30 days after the procedure. The primary endpoint was all-cause mortality at 1-year follow-up. RESULTS Among 444 patients analyzed, their mean age was 76.9 +/- 9.1 years, and 53.8% of the patients were female. The median TAPSE/PASP ratio was 0.406 mm/mm Hg (interquartile range: 0.308-0.567 mm/mm Hg). Sixty-three patients died within 1 year of TTVR, 21 with a TAPSE/PASP ratio >0.406 and 42 with a TAPSE/PASP ratio .0.406. In multivariable Cox regression analysis, a TAPSE/PASP ratio >0.406 vs .0.406 was associated with a decreased risk of all cause mortality (HR: 0.57; 95% CI: 0.35-0.93; P = 0.023). In 234 (52.7%) patients with echocardiograms 30 days after TTVR, a decline in RV-PA coupling was independently associated with reduced odds of all-cause mortality (odds ratio [OR]: 0.42; 95% CI: 0.19-0.93; P = 0.032). The magnitude of TR reduction after TTVR ($1+ vs <1+; OR: 2.53; 95% CI: 1.06-6.03; P = 0.037) was independently associated with a reduction in post-TTVR RV-PA coupling. CONCLUSIONS RV-PA coupling is a powerful, independent predictor of all-cause mortality in patients with TR undergoing TTVR. These data suggest that the TAPSE/PASP ratio can inform patient selection and prognostication following TTVR. (J Am Coll Cardiol 2022;79:448-461) (c) 2022 by the American College of Cardiology Foundation.

引用

页码：448 / 461

页数：14

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