Changing the paradigm in the management of valvular heart disease

Cardiolog

Pacemaker lead-induced tricuspid regurgitation: consider leaflet remodeling

Cardiolog

Multi-modality imaging for interventions in tricuspid valve disease

Several studies have demonstrated that severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Nowadays, several therapeutic options to treat TR are available and patients at high surgical risk can also be treated with transcatheter procedures. For the management of patients with TR, an accurate assessment of the tricuspid valve and its surrounding structures is therefore of crucial importance and has gained significant interest in the medical community. Different imaging modalities can provide detailed information on the tricuspid valve apparatus, right ventricle, right atrium, and coronary circulation which are fundamental to define the timing and anatomic suitability of surgical and percutaneous procedures. The present review illustrates the role of 2D and 3D echocardiography, cardiac magnetic resonance, and multidetector row computed tomography for the assessment of the tricuspid valve and right heart with a particular focus on the data needed for planning and guiding interventional procedures.Cardiolog

Sex-specific differences in etiology and prognosis in patients with significant tricuspid regurgitation

Cardiolog

Prognostic implications of left ventricular myocardial work indices in patients with secondary mitral regurgitation

Background: Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging but is an important parameter for risk stratification. The association of LV myocardial work components (work index [GWI], constructive [GCW] and wasted [GWW] work, and work efficiency) derived from pressure-strain loops obtained with speckle tracking echocardiography, and all-cause mortality in patients with SMR was investigated. Methods: LV myocardial GWI, GCW, GWW, and global work efficiency were measured with speckle tracking strain echocardiography in 373 patients (72% men, median age 68 years) with various grades of SMR. All-cause mortality was the primary end point. Results: Mild SMR was observed in 143 patients, 128 had moderate SMR, and 102 had severe SMR. Patients with severe SMR had the largest LV volumes and the worst LV ejection fraction and LV global longitudinal strain. In patients with severe SMR, LV GWI and GCW were more impaired (500 mm Hg% versus 680 mm Hg% P=0.024 and 678 mm Hg% versus 851 mm Hg% P=0.006, respectively), while GWW was lower (130 mm Hg% versus 260 mm Hg% P<0.001, respectively) and global work efficiency was significantly higher (82% versus 76%, P=0.001) compared with patients with mild SMR. After a median follow-up of 56 months, 161 patients died. LV GWI <= 500 mm Hg%, LV GCW <= 750 mm Hg%, and LV GWW Conclusions: Patients with severe SMR had the worst LV GWI and LV GCW but better LV GWW and global work efficiency reflecting the unloading of the LV in the low-pressure left atrial chamber. These parameters were independently associated with worse long-term survival in patients with SMR.Cardiolog

Prognostic implications of a novel algorithm to grade secondary tricuspid regurgitation

OBJECTIVES A novel tricuspid regurgitation (TR) grading system, using vena contracta (VC) width and effective regurgitant orifice area (EROA), was proposed and validated based on its prognostic usefulness.BACKGROUND The clinical need of a new grading system for TR has recently been emphasized to depict the whole spectrum of TR severity, particularly beyond severe TR (massive or torrential).METHODS TR severity was characterized in 1,129 patients with moderate or severe secondary TR (STR). Recently proposed cutoff values of VC width were more effective in differentiating the prognosis of patients with moderate STR, whereas EROA cutoff values performed better in characterizing the risk of patients with more severe STR. Therefore, these 2 parameters were combined into a novel grading system to define moderate (VC = 7 mm and EROA = 7 mm and EROA >= 80 mm(2)) STR.RESULTS A total of 143 patients (13%) showed moderate STR, whereas 536 patients (47%) had severe STR, and 450 (40%) had torrential STR. Patients with torrential STR had larger right ventricular (RV) dimensions, lower RV systolic function, and were more likely to receive diuretics. The cumulative 10-year survival rate was 53% for moderate, 45% for severe, and 35% for torrential STR (p = 0.007). After adjusting for potential confounders, torrential STR retained an association with worse prognosis compared with other STR grades (hazard ratio: 1.245; 95% confidence interval: 1.023 to 1.516; p = 0.029).CONCLUSIONS A novel STR grading system was able to capture the whole range of STR severity and identified patients with torrential STR who were characterized by a worse prognosis. (C) 2021 by the American College of Cardiology Foundation

The ASTRODEEP-GS43 catalogue: new photometry and redshifts for the CANDELS GOODS-South field

We present ASTRODEEP-GS43, a new multiwavelength photometric catalogue of the GOODS-South field, which builds and improves upon the previously released CANDELS catalogue. We provide photometric fluxes and corresponding uncertainties in 43 optical and infrared bands (25 wide and 18 medium filters), as well as photometric redshifts and physical properties of the 34930 CANDELS $H$-detected objects, plus an additional sample of 178 $H$-dropout sources, of which 173 are $Ks$-detected and 5 IRAC-detected. We keep the CANDELS photometry in 7 bands (CTIO $U$, Hubble Space Telescope WFC3 and ISAAC-$K$), and measure from scratch the fluxes in the other 36 (VIMOS, HST ACS, HAWK-I $Ks$, Spitzer IRAC, and 23 from Subaru SuprimeCAM and Magellan-Baade Fourstar) with state-of-the-art techniques of template-fitting. We then compute new photometric redshifts with three different software tools, and take the median value as best estimate. We finally evaluate new physical parameters from SED fitting, comparing them to previously published ones. Comparing to a sample of 3931 high quality spectroscopic redshifts, for the new photo-$z$'s we obtain a normalized median absolute deviation (NMAD) of 0.015 with 3.01$\%$ of outliers (0.011, 0.22$\%$ on the bright end at $I814$<22.5), similarly to the best available published samples of photometric redshifts, such as the COSMOS UltraVISTA catalogue. The ASTRODEEP-GS43 results are in qualitative agreement with previously published catalogues of the GOODS-South field, improving on them particularly in terms of SED sampling and photometric redshift estimates. The catalogue is available for download from the Astrodeep website.Comment: 15 pages, 14 figures, accepted for publication on A&

Computed tomography-derived transesophageal echocardiographic views step forward for procedural planning of transcatheter tricuspid valve annuloplasty

Cardiolog