Natural history and mid-term prognosis of severe tricuspid regurgitation: A cohort study.

OBJECTIVES The objective of this study was to characterize a population of patients with severe tricuspid regurgitation (TR) evaluated at a tertiary care center, assess mid-term clinical outcomes, and identify prognostic factors. BACKGROUND The impact of TR on morbidity and mortality is increasingly recognized. Clinical characteristics and long-term outcomes of patients suffering from TR remain unclear. METHODS This is a retrospective observational single-center study from a tertiary care hospital including patients with echocardiographic diagnosis of severe TR between January 2017 and December 2018. We used the Kaplan-Meier method to estimate survival for up to 4 years. After excluding patients with tricuspid valve (TV) intervention and surgery during follow-up, a multivariate analysis was performed to assess predictors of 2-year mortality using the Cox regression model. RESULTS A total of 278 patients (mean age 74.9 ± 13.7 years, 47.8% female) with severe TR were included in the study. The majority (83.1%; n = 231) had secondary TR. Comorbidities such as atrial fibrillation (AFib) (68.0%; n = 189), severe renal failure (44.2%; n = 123), pulmonary hypertension (PHT) (80.9%; n = 225), and right ventricular (RV) dysfunction (59.7%; n = 166) were highly prevalent. More than half of patients with a cardiac implantable electronic device (CIED) (54.3%; n = 44) showed echocardiographic signs of lead-leaflet interaction causing or contributing to TR. The estimated 2- and 4-year all-cause mortality was 50 and 69%, respectively. Using multivariate analysis, age, severe renal failure, heart failure with reduced ejection fraction (HFrEF), and vena contracta width ≥14 mm were identified as predictors of 2-year mortality. Nine percent (n = 25) of the study cohort underwent transcatheter or surgical treatment for TR during follow-up. CONCLUSION Our study shows the high burden of morbidity and the dismal survival of patients with severe TR. It also highlights the extent of the therapeutic need, since the vast majority of patients were left untreated. Additionally, CIED RV lead-associated TR was prevalent suggesting a need for more attention in clinical routine and research

A 10-year observational study on the trends and déterminants of smoking status

Introduction La plupart des études concernant la motivation et l'intention d'arrêter de fumer ont été conduites chez les adolescents et jeunes adultes mais les données concernant les sujets d'âge moyen ne sont que rares. L'objectif de cette étude était d'évaluer les tendances et déterminants du statut tabagique dans une cohort populationnelle. Méthode Etude observationnelle, prospective avec un premier suivi moyen à 5.6 ans et un second à 10.9 ans. Données récoltées à partir de 3999 participants (49.2% femmes, d'âge 35-75 ans) vivant à Lausanne (Suisse). Résultats Les prévalences au baseline des « jamais », anciens ou fumeurs actifs étaient de 41.3, 34.3 et 24.3% respectivement. Durant la période étudiée, plus de 90% des « jamais » et anciens et presque 60% des fumeurs actifs au baseline ont maintenu leur statut tabagique après 10.9 ans. Parmi 973 fumeurs actifs, 216 (22.2%) ont arrêté de fumer durant au moins 5 ans. Les analyses multivariables ont montré que l'augmentation de l'âge est positivement associée avec l'arrêt du tabagisme (p-value pour la tendance <0.001). Parmi 1373 anciens fumeurs, 149 (10.9%) ont rechuté ; l'augmentation de l'âge (p-value pour la tendance<0.001) était négativement associée et l'anamnèse familiale de maladie pulmonaire était positivement associée à la rechute [OR and 95% CI: 1.53 (1.06±2.21)]. Parmi 1653 «jamais» fumeurs, 128 (7.7%) ont commencé à fumer. Le genre masculin [1.46 (1.01±2.12)] et vivre en couple [0.66 (0.45±0.97)] étaient associés à l'initiation du tabagisme. Conclusion La plupart des sujets d'âge moyen « jamais » ou anciens fumeurs n'ont pas changé leur statut tabagique avec le temps, alors que 22.2% des fumeurs actifs ont arrêté de fumer durablement. Ces résultats sont encourageants et pourraient être encore améliorés avec des méthodes de soutien appropriées. En comparaison avec à littérature actuelle, cette étude confirme la difficulté à identifier les sujets à risque de changement comportemental négatif

Contemporary Approach of Tricuspid Regurgitation: Knowns, Unknowns and Future Challenges.

Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late and tricuspid valve (TV) interventions (surgical or transcatheter) are underutilized, which leads to irreversible right ventricular (RV) damage and increases the risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomized controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared to medical treatment

Sex-Specific Differences in Upstream Cardiac Damage in Patients With Aortic Stenosis Undergoing TAVR.

BACKGROUND Cardiac damage caused by aortic stenosis (AS) can be categorized into stages, which are associated with a progressively increasing risk of death after transcatheter aortic valve replacement (TAVR). OBJECTIVES The authors investigated sex-related differences in cardiac damage among patients with symptomatic AS and the prognostic value of cardiac damage classification in women and men undergoing TAVR. METHODS In a prospective registry, pre-TAVR echocardiograms were used to categorize patients into 5 stages of cardiac damage caused by AS. Differences in the extent of cardiac damage were compared according to sex, and its implications on clinical outcomes after TAVR were explored. RESULTS Among 2,026 patients undergoing TAVR between August 2007 and June 2022 (995 [49.1%] women and 1,031 [50.9%] men), we observed sex-specific differences in the pattern of cardiac damage (women vs men; stage 0: 2.6% vs 3.1%, stage 1: 13.4% vs 10.1%, stage 2: 37.1% vs 39.5%, stage 3: 27.5% vs 15.6%, and stage 4: 19.4% vs 31.7%). There was a stepwise increase in 5-year all-cause mortality according to stage in women (HRadjusted: 1.43; 95% CI: 1.28-1.60, for linear trend) and men (HRadjusted: 1.26; 95% CI: 1.14-1.38, for linear trend). Female sex was associated with a lower 5-year mortality in early stages (stage 0, 1, or 2) but not in advanced stages (stage 3 or 4). CONCLUSIONS The pattern of cardiac damage secondary to AS differed by sex. In early stages of cardiac damage, women had a lower 5-year mortality than men, whereas in more advanced stages, mortality was comparable between sexes. (SwissTAVI Registry; NCT01368250)

A 10-year observational study on the trends and determinants of smoking status

<div><p>Introduction</p><p>Most studies on motivation and intention to quit smoking have been conducted among adolescents and young adults but little is known regarding middle-aged subjects. We aimed to assess the trends and determinants of smoking status in a population-based cohort.</p><p>Method</p><p>Observational, prospective study with a first mean follow-up at 5.6 years and a second at 10.9 years. Data from 3999 participants (49.2% women, aged 35–75 years) living in Lausanne (Switzerland).</p><p>Results</p><p>Baseline prevalence of never, former and current smokers was 41.3, 34.3 and 24.3%, respectively. During the study period, more than 90% of never and former and almost 60% of current smokers at baseline retained their status after 10.9 years. Among 973 current smokers, 216 (22.2%) had quit for at least 5 years. Multivariable analysis showed increasing age to be positively associated with quitting (p-value for trend <0.001). Among 1373 former smokers, 149 (10.9%) had relapsed; increasing age (p-value for trend <0.001) was negatively associated and family history of lung disease was positively associated with relapse [OR and 95% CI: 1.53 (1.06–2.21)]. Among 1653 never smokers, 128 (7.7%) initiated smoking; Male gender [1.46 (1.01–2.12)] and living in coupled relationship [0.66 (0.45–0.97)] were associated with smoking initiation.</p><p>Conclusion</p><p>Most middle-aged never and former smokers did not change their status with time, while 22.2% of current smokers sustained quitting. This is encouraging and could be improved with adequate supportive methods. In comparison to available data, this study confirms the difficult task of identifying subjects at risk of a negative behavioral change.</p></div

Acute Heart Failure During the Peripartum Period Due to Aggravated Tricuspid Regurgitation.

Latent valvular heart disease may be aggravated or demasked during pregnancy because of physiologic hemodynamic changes, including higher circulating volume, heart rate, and cardiac index, as well as stress during labor. The presence of valvular heart disease increases the risk of maternal and fetal/newborn adverse events. Early diagnosis, risk assessment, and specific management are crucial. We present a case of acute peripartal heart failure caused by idiopathic severe tricuspid regurgitation in a 38-year-old woman

Number of participants excluded and retained for analysis.

<p>Number of participants excluded and retained for analysis.</p

Bivariate analysis of the factors associated with initiation, relapse or quitting smoking, CoLaus study, Lausanne, Switzerland.

<p>Bivariate analysis of the factors associated with initiation, relapse or quitting smoking, CoLaus study, Lausanne, Switzerland.</p