Kresoja Karl-Patrik, Rosch Sebastian, Schöber Anne Rebecca, Fengler Karl, Schlotter Florian, Bombace Sara, Sagmeister Paula, von Roeder Maximilian, Kister Tobias, Gutberlet Matthias, Thiele Holger, Rommel Karl-Philipp, Lurz Philipp
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany.
Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Mainz, Germany.
Eur J Heart Fail. 2024 Apr;26(4):1025-1035. doi: 10.1002/ejhf.3195. Epub 2024 Mar 11.
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.
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).
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.
本研究旨在通过使用经导管三尖瓣缘对缘修复术（T-TEER）作为右心室（RV）容量过载缓解模型，评估射血分数保留的心力衰竭（HFpEF）患者中重度三尖瓣反流（TR）的病理生理意义。
这项前瞻性干预单臂试验（NCT04782908）纳入了经侵入性诊断为HFpEF的患者。在T-TEER前后前瞻性评估以下参数：通过侵入性压力-容积环记录评估左心室（LV）舒张特性；通过心脏磁共振成像评估双心室时间-容积曲线、功能以及室间隔曲率；进行室间隔运动时间的应变分析。总共纳入了20例患者（中位年龄78岁，四分位间距[IQR]为72 - 83岁，65%为女性）。T-TEER使TR程度中位数降低了2（共5级）级（IQR为2 - 1）。T-TEER增加了LV每搏输出量和LV舒张末期容积（LVEDV）（p < 0.001），而未增加LV舒张末期压力（LVEDP）（p = 0.094），因此舒张功能得到改善，LVEDP/LVEDV降低（p = 0.001），舒张末期压力-容积关系向右移位。LVEDV的增加与RV舒张末期容积的减少相关（p < 0.001），LV跨壁压升高（p = 0.028）。由于早期RV充盈减少，观察到早期LV充盈改善，这与室间隔向左弯曲减轻相关（分别为p < 0.01）。
HFpEF和重度TR患者的LV舒张特性在很大程度上由RV容量过载情况下的心室相互作用决定。T-TEER减少了RV容量过载，改善了双心室相互作用和生理功能。
