Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
JACC Cardiovasc Interv. 2021 Jul 26;14(14):1551-1561. doi: 10.1016/j.jcin.2021.05.005.
This study investigated patterns of right ventricular (RV) contraction by using cardiac magnetic resonance (CMR) imaging in patients undergoing transcatheter tricuspid valve repair (TTVR).
The role of RV function in patients with severe tricuspid regurgitation undergoing TTVR is poorly understood.
Global RV dysfunction was defined as CMR-derived RV ejection fraction (RVEF) ≤45% and longitudinal RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm on echocardiography. Patients were stratified into 3 types of RV contraction: type I, TAPSE ≥17 and RVEF >45%; type II, TAPSE <17 and RVEF >45%; and type III, TAPSE <17 and RVEF ≤45%. CMR feature tracking was performed to assess longitudinal and circumferential RV strain. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization.
Of 79 patients (median age 79 years, 51% female), 18 (23%) presented with global and 40 (51%) presented with longitudinal RV dysfunction. The composite outcome occurred in 22 patients (median follow-up 362 days). Global RV dysfunction but not longitudinal RV dysfunction (hazard ratio: 6.62; 95% confidence interval: 2.77-15.77; and hazard ratio: 1.30; 95% confidence interval: 0.55-3.08, respectively) was associated with the composite outcome. Compared with type I RV contraction, patients with type II RV contraction exhibited increased circumferential strain, with a preservation of RVEF despite diminished longitudinal strain. Patients with type III RV contraction exhibited both diminished longitudinal and circumferential strain, resulting in an impaired RVEF. Patients with type III RV contraction showed the worst survival (P < 0.001).
Global RV dysfunction is a predictor of outcomes among TTVR patients. Tricuspid regurgitation patients can be stratified into 3 types of RV contraction, in which a loss of longitudinal function can be compensated by increasing circumferential function, preserving RVEF and favorable outcomes.
本研究通过心脏磁共振（CMR）成像调查行经导管三尖瓣修复术（TTVR）的患者右心室（RV）收缩模式。
严重三尖瓣反流患者行 TTVR 时 RV 功能的作用尚不清楚。
通过 CMR 获得的 RV 射血分数（RVEF）≤45%定义为整体 RV 功能障碍，超声心动图上三尖瓣环平面收缩期位移（TAPSE）<17mm 定义为 RV 纵向功能障碍。将患者分为 3 种 RV 收缩类型：I 型，TAPSE≥17 和 RVEF>45%；II 型，TAPSE<17 和 RVEF>45%；III 型，TAPSE<17 和 RVEF≤45%。采用 CMR 特征跟踪评估 RV 纵向和环向应变。主要终点是全因死亡率或首次心力衰竭住院的复合终点。
在 79 名患者（中位年龄 79 岁，51%为女性）中，18 名（23%）存在整体 RV 功能障碍，40 名（51%）存在 RV 纵向功能障碍。22 名患者发生复合终点事件（中位随访 362 天）。整体 RV 功能障碍而不是 RV 纵向功能障碍（风险比：6.62；95%置信区间：2.77-15.77；和风险比：1.30；95%置信区间：0.55-3.08）与复合终点相关。与 I 型 RV 收缩相比，II 型 RV 收缩的患者表现出环向应变增加，尽管纵向应变降低，但 RVEF 仍保持不变。III 型 RV 收缩的患者表现出纵向和环向应变均降低，导致 RVEF 受损。III 型 RV 收缩的患者生存率最差（P<0.001）。
整体 RV 功能障碍是 TTVR 患者结局的预测因素。三尖瓣反流患者可分为 3 种 RV 收缩类型，其中纵向功能丧失可通过增加环向功能来代偿，从而保持 RVEF 和良好的结局。
