Stolz Lukas, Weckbach Ludwig T, Glaser Hannah, Doldi Philipp M, Schmid Simon, Stocker Thomas J, Hagl Christian, Näbauer Michael, Massberg Steffen, Hausleiter Jörg
Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. Electronic address: https://twitter.com/stolz_l.
Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. Electronic address: https://twitter.com/LT_Weckbach.
JACC Cardiovasc Interv. 2024 Dec 9;17(23):2811-2822. doi: 10.1016/j.jcin.2024.09.069.
Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has been reported to be associated with right ventricular reverse remodeling (RVRR). Data on the temporal evolution of this phenomenon are scarce.
The aim of this study was to evaluate RVRR over the course of 2-year follow-up after T-TEER using sequential 3-dimensional echocardiograms (3DE).
The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1 month, 6 months, as well as 1 and 2 years. The 3DE evaluation included right ventricular volumes (right ventricular end-diastolic volume [RVEDV]; right ventricular end-systolic volume [RVESV]), right ventricular ejection fraction (RVEF), and RV longitudinal strain of the free wall and the septum.
The study included 231 patients (median age 82 [IQR: 79-86] years, 48% women). We observed a biphasic pattern of RVRR following T-TEER consisting of early RV volume unloading (phase 1, reduced RVEDV) and later structural remodeling (phase 2, reduced RVESV). Whereas RVEDV was significantly reduced early after the procedure (-9.7% from baseline to discharge; P < 0.001), RVESV remained unchanged at 1-month follow-up. Reduction in RVESV was observed at 6-month follow-up for the first time (-5.4% from baseline to 6-month follow-up; P < 0.001). Reduction in both RVEDV and RVESV peaked at 1-year follow-up and remained stable until 2 years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF at baseline 42.2% ± 8.9%, discharge 31.1% ± 9.4%, 2-year follow-up 41.6% ± 8.9%). The 3D RV longitudinal strain of the septum and 3D RV longitudinal strain of the free wall developed analogously.
RVRR following T-TEER occurs in 2 stages and involves early RV unloading (reduction in RVEDV) and later structural RVRR (reduction in RVESV) with an improvement in RVEF.
据报道，经导管三尖瓣缘对缘修复术（T-TEER）与右心室逆向重构（RVRR）有关。关于这一现象的时间演变的数据很少。
本研究的目的是使用连续三维超声心动图（3DE）评估T-TEER术后2年随访期间的RVRR情况。
该研究纳入了在基线和出院时可获得3DE的T-TEER患者。进一步的随访安排在1个月、6个月以及1年和2年。3DE评估包括右心室容积（右心室舒张末期容积[RVEDV]；右心室收缩末期容积[RVESV]）、右心室射血分数（RVEF）以及游离壁和室间隔的右心室纵向应变。
该研究纳入了231例患者（中位年龄82岁[四分位间距：79 - 86岁]，48%为女性）。我们观察到T-TEER术后RVRR呈双相模式，包括早期右心室容积减少（第1阶段，RVEDV降低）和后期结构重塑（第2阶段，RVESV降低）。尽管术后早期RVEDV显著降低（从基线到出院降低9.7%；P < 0.001），但在1个月随访时RVESV保持不变。首次在6个月随访时观察到RVESV降低（从基线到6个月随访降低5.4%；P < 0.001）。RVEDV和RVESV的降低在1年随访时达到峰值，并在T-TEER术后2年保持稳定。T-TEER术后早期右心室功能下降，在随访过程中逐渐增加（基线时RVEF为42.2% ± 8.9%，出院时为31.1% ± 9.4%，2年随访时为41.6% ± 8.9%）。室间隔的三维右心室纵向应变和游离壁的三维右心室纵向应变变化类似。
T-TEER术后的RVRR分两个阶段发生，包括早期右心室减负（RVEDV降低）和后期结构性RVRR（RVESV降低），同时RVEF有所改善。
