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Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction
Aims 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 overlo...
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| Published in: | European journal of heart failure 2024-04, Vol.26 (4), p.1025-1035 |
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| container_title | European journal of heart failure |
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| creator | Kresoja, Karl‐Patrik Rosch, Sebastian Schöber, Anne Rebecca Fengler, Karl Schlotter, Florian Bombace, Sara Sagmeister, Paula Roeder, Maximilian Kister, Tobias Gutberlet, Matthias Thiele, Holger Rommel, Karl‐Philipp Lurz, Philipp |
| description | Aims
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.
Methods and results
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 |
| doi_str_mv | 10.1002/ejhf.3195 |
| format | article |
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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.
Methods and results
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).
Conclusion
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.</description><identifier>ISSN: 1388-9842</identifier><identifier>ISSN: 1879-0844</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.3195</identifier><identifier>PMID: 38462987</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Aged, 80 and over ; Cardiac Catheterization - methods ; Cardiac magnetic resonance imaging ; Diastole ; Female ; Heart Failure - complications ; Heart Failure - physiopathology ; Heart failure with preserved ejection fraction ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Magnetic Resonance Imaging, Cine - methods ; Male ; Prospective Studies ; Stroke Volume - physiology ; Transcatheter tricuspid valve repair ; Tricuspid regurgitation ; Tricuspid Valve Insufficiency - complications ; Tricuspid Valve Insufficiency - physiopathology ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Function, Left - physiology ; Ventricular Function, Right - physiology</subject><ispartof>European journal of heart failure, 2024-04, Vol.26 (4), p.1025-1035</ispartof><rights>2024 The Authors. published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</rights><rights>2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3605-de4e30967669cbb2286c86d23e56971a75c76250ad5d074675a9fe5914bbb5be3</citedby><cites>FETCH-LOGICAL-c3605-de4e30967669cbb2286c86d23e56971a75c76250ad5d074675a9fe5914bbb5be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38462987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kresoja, Karl‐Patrik</creatorcontrib><creatorcontrib>Rosch, Sebastian</creatorcontrib><creatorcontrib>Schöber, Anne Rebecca</creatorcontrib><creatorcontrib>Fengler, Karl</creatorcontrib><creatorcontrib>Schlotter, Florian</creatorcontrib><creatorcontrib>Bombace, Sara</creatorcontrib><creatorcontrib>Sagmeister, Paula</creatorcontrib><creatorcontrib>Roeder, Maximilian</creatorcontrib><creatorcontrib>Kister, Tobias</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Rommel, Karl‐Philipp</creatorcontrib><creatorcontrib>Lurz, Philipp</creatorcontrib><title>Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims
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.
Methods and results
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).
Conclusion
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiac Catheterization - methods</subject><subject>Cardiac magnetic resonance imaging</subject><subject>Diastole</subject><subject>Female</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - physiopathology</subject><subject>Heart failure with preserved ejection fraction</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Stroke Volume - physiology</subject><subject>Transcatheter tricuspid valve repair</subject><subject>Tricuspid regurgitation</subject><subject>Tricuspid Valve Insufficiency - complications</subject><subject>Tricuspid Valve Insufficiency - physiopathology</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><subject>Ventricular Function, Left - physiology</subject><subject>Ventricular Function, Right - physiology</subject><issn>1388-9842</issn><issn>1879-0844</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp10LtOwzAUBmALgaAUBl4AeYQh4DjxbURVS0FILDBHjnPSunIu2ElRH4J3Jk2BjekcnfPpH36ErmJyFxNC72GzLu-SWLEjNImlUBGRaXo87ImUkZIpPUPnIWwIicXAT9FZIlNOlRQT9PVUtc4a3dmmDrgpceet6UNrC-xh1fuV7cYf1vVwsat1h7dQj8hpj7eN6yvAzRa8a3SBbY3bwQ8i4E_brfEatO9wqa3rPRxOrYcAfgsFhg2YMbz0elwu0EmpXYDLnzlF74v522wZvbw-Ps0eXiKTcMKiAlJIiOKCc2XynFLJjeQFTYBxJWItmBGcMqILVhCRcsG0KoGpOM3znOWQTNHNIbf1zUcPocsqGww4p2to-pBRxRjlUnI-0NsDNb4JwUOZtd5W2u-ymGT79rN9-9m-_cFe_8T2eQXFn_ytewD3B_BpHez-T8rmz8vFGPkNhfqS9w</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Kresoja, Karl‐Patrik</creator><creator>Rosch, Sebastian</creator><creator>Schöber, Anne Rebecca</creator><creator>Fengler, Karl</creator><creator>Schlotter, Florian</creator><creator>Bombace, Sara</creator><creator>Sagmeister, Paula</creator><creator>Roeder, Maximilian</creator><creator>Kister, Tobias</creator><creator>Gutberlet, Matthias</creator><creator>Thiele, Holger</creator><creator>Rommel, Karl‐Philipp</creator><creator>Lurz, Philipp</creator><general>John Wiley & Sons, Ltd</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202404</creationdate><title>Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction</title><author>Kresoja, Karl‐Patrik ; Rosch, Sebastian ; Schöber, Anne Rebecca ; Fengler, Karl ; Schlotter, Florian ; Bombace, Sara ; Sagmeister, Paula ; Roeder, Maximilian ; Kister, Tobias ; Gutberlet, Matthias ; Thiele, Holger ; Rommel, Karl‐Philipp ; Lurz, Philipp</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3605-de4e30967669cbb2286c86d23e56971a75c76250ad5d074675a9fe5914bbb5be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiac Catheterization - methods</topic><topic>Cardiac magnetic resonance imaging</topic><topic>Diastole</topic><topic>Female</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - physiopathology</topic><topic>Heart failure with preserved ejection fraction</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Stroke Volume - physiology</topic><topic>Transcatheter tricuspid valve repair</topic><topic>Tricuspid regurgitation</topic><topic>Tricuspid Valve Insufficiency - complications</topic><topic>Tricuspid Valve Insufficiency - physiopathology</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><topic>Ventricular Function, Left - physiology</topic><topic>Ventricular Function, Right - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kresoja, Karl‐Patrik</creatorcontrib><creatorcontrib>Rosch, Sebastian</creatorcontrib><creatorcontrib>Schöber, Anne Rebecca</creatorcontrib><creatorcontrib>Fengler, Karl</creatorcontrib><creatorcontrib>Schlotter, Florian</creatorcontrib><creatorcontrib>Bombace, Sara</creatorcontrib><creatorcontrib>Sagmeister, Paula</creatorcontrib><creatorcontrib>Roeder, Maximilian</creatorcontrib><creatorcontrib>Kister, Tobias</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Rommel, Karl‐Philipp</creatorcontrib><creatorcontrib>Lurz, Philipp</creatorcontrib><collection>Wiley-Blackwell Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kresoja, Karl‐Patrik</au><au>Rosch, Sebastian</au><au>Schöber, Anne Rebecca</au><au>Fengler, Karl</au><au>Schlotter, Florian</au><au>Bombace, Sara</au><au>Sagmeister, Paula</au><au>Roeder, Maximilian</au><au>Kister, Tobias</au><au>Gutberlet, Matthias</au><au>Thiele, Holger</au><au>Rommel, Karl‐Philipp</au><au>Lurz, Philipp</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2024-04</date><risdate>2024</risdate><volume>26</volume><issue>4</issue><spage>1025</spage><epage>1035</epage><pages>1025-1035</pages><issn>1388-9842</issn><issn>1879-0844</issn><eissn>1879-0844</eissn><abstract>Aims
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.
Methods and results
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).
Conclusion
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.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>38462987</pmid><doi>10.1002/ejhf.3195</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of heart failure, 2024-04, Vol.26 (4), p.1025-1035 |
| issn | 1388-9842 1879-0844 1879-0844 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Aged Aged, 80 and over Cardiac Catheterization - methods Cardiac magnetic resonance imaging Diastole Female Heart Failure - complications Heart Failure - physiopathology Heart failure with preserved ejection fraction Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Magnetic Resonance Imaging, Cine - methods Male Prospective Studies Stroke Volume - physiology Transcatheter tricuspid valve repair Tricuspid regurgitation Tricuspid Valve Insufficiency - complications Tricuspid Valve Insufficiency - physiopathology Ventricular Dysfunction, Right - physiopathology Ventricular Function, Left - physiology Ventricular Function, Right - physiology |
| title | Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction |
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