排序方式: 共有33条查询结果,搜索用时 15 毫秒
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Philipp E. Bartko Henrike Arfsten Maria K. Frey Gregor Heitzinger Noemi Pavo Anna Cho Stephanie Neuhold Timothy C. Tan Guido Strunk Christian Hengstenberg Martin Hülsmann Georg Goliasch 《JACC: Cardiovascular Imaging》2019,12(3):389-397
Objectives
This study sought to define the relationship between functional tricuspid regurgitation (TR) and mortality in patients with heart failure with reduced ejection fraction (HFrEF); and to establish the prognostic value of quantitative measures of TR severity (i.e., effective regurgitant orifice area [EROA] and regurgitant volume).Background
The significance of TR in chronic heart failure is controversial. Earlier studies have shown an independent impact of TR on mortality, whereas more recent evidence suggests myocardial impairment to be the driving force of mortality rather than TR itself. Earlier studies have used qualitative measures of TR severity, hence the prognostic value of more quantitative measures of TR severity (i.e., EROA and regurgitant volumes) remains unclear.Methods
We enrolled 382 patients with HFrEF on guideline-directed medical therapy and assessed TR EROA and regurgitant volume by Doppler/2-dimensional echocardiography. All-cause mortality was defined as the primary study endpoint.Results
TR severity was associated with the HFrEF phenotype with more symptoms (p = 0.004), higher neurohumoral activation (p < 0.001), progressive right-ventricular dilatation (p < 0.001), and impaired function (p < 0.001). Cox regression showed a strong association between quantitative measures of TR with mortality (all p < 0.001). Quantitative metrics of TR severity were consistently associated with mortality with a hazard ratio of 1.009 (95% confidence interval: 1.004 to 1.013; p < 0.001) per 0.01 cm2 increase of the EROA and of 1.013 (95% confidence interval: 1.007 to 1.020; p < 0.001) per 1-ml increase in regurgitant volume. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. A spline curve pattern illustrates the association with mortality with thresholds for the EROA ≥0.2 cm2, and the regurgitant volume ≥20 ml with sustained excess mortality thereafter.Conclusions
This large-scale outcome study demonstrates the prognostic value of quantitative Doppler-echocardiographic measures of TR severity in HFrEF. The thresholds for EROA and TR regurgitant volume associated with mortality in our study fall within current ranges defining nonsevere TR. This may potentially impact therapeutic decision making, particularly timing of intervention. 相似文献3.
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Lluis Asmarats Gidon Perlman Fabien Praz Mark Hensey Michael P. Chrissoheris Francois Philippon Hadass Ofek Jian Ye Rishi Puri Philippe Pibarot Adrian Attinger Robert Moss Elisabeth Bédard Aris Moschovitis David Reineke Sandra Lauck Philipp Blanke Jonathon Leipsic Josep Rodés-Cabau 《JACC: Cardiovascular Interventions》2019,12(15):1438-1447
ObjectivesTo evaluate the long-term (≥2 years) outcomes following transcatheter tricuspid valve repair (TTVr) with the FORMA Transcatheter Tricuspid Valve Repair System (Edwards Lifesciences, Irvine, California).BackgroundScarce data exist on long-term outcomes following TTVr.MethodsThis multicenter experience included patients with severe tricuspid regurgitation (TR) who underwent TTVr with the FORMA system at 4 centers under a compassionate clinical use program. Data were collected at baseline, 30 days, and 1 year, and yearly thereafter.ResultsNineteen patients (76 ± 9 years of age, 74% women, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation] 9.2 ± 5.6%) with functional TR were included. Procedural success was achieved in 17 (89%) patients and there were no cases of 30-day mortality. At a median follow-up of 32 (interquartile range: 24 to 36) months, 4 (24%) patients had died (3 from terminal heart failure, 1 from sepsis) and 3 (18%) patients required rehospitalization for heart failure. There was 1 device-related thrombosis and 1 pulmonary embolism, both in the setting of subtherapeutic oral anticoagulation. Less than severe TR was observed at echocardiography in 67% of patients at the 2- to 3-year follow-up. Among 15 successfully implanted patients with at least 24-month follow-up, significant improvements in New York Heart Association functional class (p < 0.001), 6-min walk test (+54 m; p = 0.016) and Kansas City Cardiomyopathy Questionnaire score (+16 points; p = 0.016) were observed, compared with baseline.ConclusionsTTVr using the FORMA system showed favorable long-term safety profile in high-surgical-risk patients, with sustained functional improvement and acceptable TR reduction up to 3 years. 相似文献
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Seth Uretsky Edgar Argulian Jagat Narula Steven D. Wolff 《Journal of the American College of Cardiology》2018,71(5):547-563
Accurate quantification of regurgitant volume is a central component to the management of mitral regurgitation. Cardiac magnetic resonance imaging (CMR) accurately quantifies mitral regurgitation as the difference between left ventricular stroke volume and forward stroke volume using steady state free precession and phase contrast imaging. The CMR measurement of mitral regurgitant volume is reproducible and can quantify mitral regurgitation in patients without regard to regurgitant jet morphology, such as patients with multiple and eccentric jets. It can be used to quantify regurgitant volume in patients with multiple valve lesions and concomitant intracardiac shunts without the use of intravenous contrast. Studies have highlighted the accuracy and reproducibility of CMR in quantifying mitral regurgitation and have begun to link CMR to clinical outcomes. 相似文献
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Fabien Praz Omar K. Khalique Leon G. Dos Reis Macedo Todd C. Pulerwitz Jennifer Jantz Isaac Y. Wu Alex Kantor Amisha Patel Torsten Vahl Vinayak Bapat Isaac George Tamim Nazif Susheel K. Kodali Martin B. Leon Rebecca T. Hahn 《Journal of the American Society of Echocardiography》2018,31(11):1190-1202.e3