ECHOCARDIOGRAPHIC CHARACTERISTICS OF HEART FAILURE PATIENTS WITH SEVERE TRICUSPID REGURGITATION
CCC ePoster Library. Kiwan C. 10/26/19; 280528; 293
Dr. Chrystina Kiwan
Dr. Chrystina Kiwan
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Abstract
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BACKGROUND: The proportion of patients with heart failure (HF) and severe tricuspid regurgitation (TR) that are potential candidates for a percutaneous tricuspid valve intervention is unknown. The aim of this study was to evaluate in a real-world setting the echocardiographic characteristics of Heart Failure HF patients with severe TR.

METHODS AND RESULTS: This was a retrospective cohort study of 2133 adult patients enrolled in the HF clinic at the McGill University Health Center from 2007 to 2017, totaling 10 300 echocardiograms. Included in our study were patients with a clinical diagnosis of HF and available echocardiographic follow up. All data after heart transplant or ventricular assist device was excluded. The severity of TR was classified according to the American Society of Echocardiography guidelines. All patients who never had severe TR during their follow-up were included in the control group. Results: There were 321 patients with severe TR at any time during the follow-up period (mean age 66±16 years; 61% male), whereas 1812 patients did not have severe TR (mean age 60±15 years; 60% male). Among patients with severe TR, left ventricular ejection fraction (LVEF) was low (≤50%) in 76%, compared to the control group in which LVEF was low in 71% (p=0.07). Severe mitral regurgitation (MR) was present in 26% of the severe TR group compared to 5% in the control group (p < 0.0001). Moreover, elevated pulmonary artery systolic pressure (PASP) (>50mmHg) was present in 53% of the severe TR group, compared to 20% in control group (p < 0.0001). Moderate and severe right ventricular (RV) systolic dysfunction were present in 34% and 12% of the severe TR group, respectively. However, in controls moderate and severe RV dysfunction was present in only 10% and 2%, respectively (p < 0.0001). Finally, severe RV dilatation was present in 28% and moderate RV dilatation in 33% of the severe TR groups as compared to the control group with 3% with severe dilatation and 6% with moderate RV dilatation (p < 0.0001). Approximately 50% of patients with severe TR had less than moderate RV dilatation and systolic dysfunction. This subgroup could be eligible for a tricuspid valve intervention.

CONCLUSION: In patients with HF, severe TR is associated with worse echocardiographic parameters including severe MR, pulmonary hypertension, RV dilatation and RV systolic dysfunction. Half of patients with severe TR could be eligible for tricuspid valve intervention.
BACKGROUND: The proportion of patients with heart failure (HF) and severe tricuspid regurgitation (TR) that are potential candidates for a percutaneous tricuspid valve intervention is unknown. The aim of this study was to evaluate in a real-world setting the echocardiographic characteristics of Heart Failure HF patients with severe TR.

METHODS AND RESULTS: This was a retrospective cohort study of 2133 adult patients enrolled in the HF clinic at the McGill University Health Center from 2007 to 2017, totaling 10 300 echocardiograms. Included in our study were patients with a clinical diagnosis of HF and available echocardiographic follow up. All data after heart transplant or ventricular assist device was excluded. The severity of TR was classified according to the American Society of Echocardiography guidelines. All patients who never had severe TR during their follow-up were included in the control group. Results: There were 321 patients with severe TR at any time during the follow-up period (mean age 66±16 years; 61% male), whereas 1812 patients did not have severe TR (mean age 60±15 years; 60% male). Among patients with severe TR, left ventricular ejection fraction (LVEF) was low (≤50%) in 76%, compared to the control group in which LVEF was low in 71% (p=0.07). Severe mitral regurgitation (MR) was present in 26% of the severe TR group compared to 5% in the control group (p < 0.0001). Moreover, elevated pulmonary artery systolic pressure (PASP) (>50mmHg) was present in 53% of the severe TR group, compared to 20% in control group (p < 0.0001). Moderate and severe right ventricular (RV) systolic dysfunction were present in 34% and 12% of the severe TR group, respectively. However, in controls moderate and severe RV dysfunction was present in only 10% and 2%, respectively (p < 0.0001). Finally, severe RV dilatation was present in 28% and moderate RV dilatation in 33% of the severe TR groups as compared to the control group with 3% with severe dilatation and 6% with moderate RV dilatation (p < 0.0001). Approximately 50% of patients with severe TR had less than moderate RV dilatation and systolic dysfunction. This subgroup could be eligible for a tricuspid valve intervention.

CONCLUSION: In patients with HF, severe TR is associated with worse echocardiographic parameters including severe MR, pulmonary hypertension, RV dilatation and RV systolic dysfunction. Half of patients with severe TR could be eligible for tricuspid valve intervention.
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