{"title":"三尖瓣经导管边缘到边缘修复后心脏重构:从右心室到左心室","authors":"T.B. Bourcier, T.R. Raoult, T.B. Benard, S.W. Willoteaux, F.P. Pinaud, F.P. Prunier, A.F. Furber, F.R. Rouleau, L.B. Biere","doi":"10.1016/j.acvdsp.2023.04.054","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>The management of isolated functional tricuspid regurgitation (TR) is under ongoing investigations as recent interventional breakthrough, such as transcatheter edge-to-edge repair (TEER). We aimed to assess whether and how such device would affect right and left reverse remodeling over time.</p></div><div><h3>Method</h3><p><span>This is a monocentric, prospective cohort of 10 consecutive patients treated by TEER between 2019 and 2022 who underwent successive cardiac magnetic resonance. Clinical and echocardiographic follow-up was performed up to 12</span> <!-->months after intervention.</p></div><div><h3>Results</h3><p>Overall patients were 81 [IQR: 77.5; 84.0] years old and 6 (60%) were women. TTE derived TR was reduced to stage moderate or less in 80% patients (<em>n</em> <!-->=<!--> <!-->8) at discharge (<em>P</em> <!--><<!--> <!-->0.001) and in 77% (<em>n</em> <!-->=<!--> <!-->7) at 1<!--> <!-->year (<em>P</em> <!--><<!--> <span>0.001) compared with 0% at baseline. CMR-derived Left ventricular ejection fraction (LVEF) and left cardiac output improved from 45 [IQR: 40; 56]% to 57 [IQR: 47; 57]% (</span><em>P</em> <!-->=<!--> <!-->0.019) and from 2.6 [IQR: 2.1; 2.9] L/min/m<sup>2</sup> to 3.1 [IQR: 2.6; 3.7] L/min/m<sup>2</sup> (<em>P</em> <!-->=<!--> <!-->0.020). The interobserver reliability of LVEF before and after TEER was r<sup>2</sup> <!-->=<!--> <!-->0.95 (<em>P</em> <!--><<!--> <!-->0.001) versus 0.95 (<em>P</em> <!--><<!--> <span>0.001). Right ventricle end-diastolic volume (RVEDV) decreased from 107</span> <!-->mL/m<sup>2</sup> [IQR: 75; 138] to 87 [IQR: 67; 115.0] mL/m<sup>2</sup> (<em>P</em> <!-->=<!--> <span>0.039). There was no change in native T1 mapping. We found no non-ischemic late gadolinium enhancement. At 12</span> <span>months, 67% of CMR patients presented with NYHA class I/II and KCCQ overall summery score increased from baseline 46 [IQR: 30.0; 49.1] to 66 [IQR: 57.4; 73.9] (</span><em>P</em> <!-->=<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>TR TEER led to encouraging reverse remodeling of the left ventricle<span>, combining a large increase in LVEF, cardiac output and LV stroke volumes. As we found no changes in myocardial fibrosis, our results suggest a tight interdependence between both ventricles and question the role played by the RV on left ventricular efficiency. Outcomes were consistent with clinical amelioration.</span></p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 269"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cardiac remodeling after tricuspid transcatheter edge-to-edge repair: From the right to the left ventricle\",\"authors\":\"T.B. Bourcier, T.R. Raoult, T.B. Benard, S.W. Willoteaux, F.P. Pinaud, F.P. Prunier, A.F. Furber, F.R. Rouleau, L.B. Biere\",\"doi\":\"10.1016/j.acvdsp.2023.04.054\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>The management of isolated functional tricuspid regurgitation (TR) is under ongoing investigations as recent interventional breakthrough, such as transcatheter edge-to-edge repair (TEER). We aimed to assess whether and how such device would affect right and left reverse remodeling over time.</p></div><div><h3>Method</h3><p><span>This is a monocentric, prospective cohort of 10 consecutive patients treated by TEER between 2019 and 2022 who underwent successive cardiac magnetic resonance. Clinical and echocardiographic follow-up was performed up to 12</span> <!-->months after intervention.</p></div><div><h3>Results</h3><p>Overall patients were 81 [IQR: 77.5; 84.0] years old and 6 (60%) were women. TTE derived TR was reduced to stage moderate or less in 80% patients (<em>n</em> <!-->=<!--> <!-->8) at discharge (<em>P</em> <!--><<!--> <!-->0.001) and in 77% (<em>n</em> <!-->=<!--> <!-->7) at 1<!--> <!-->year (<em>P</em> <!--><<!--> <span>0.001) compared with 0% at baseline. CMR-derived Left ventricular ejection fraction (LVEF) and left cardiac output improved from 45 [IQR: 40; 56]% to 57 [IQR: 47; 57]% (</span><em>P</em> <!-->=<!--> <!-->0.019) and from 2.6 [IQR: 2.1; 2.9] L/min/m<sup>2</sup> to 3.1 [IQR: 2.6; 3.7] L/min/m<sup>2</sup> (<em>P</em> <!-->=<!--> <!-->0.020). The interobserver reliability of LVEF before and after TEER was r<sup>2</sup> <!-->=<!--> <!-->0.95 (<em>P</em> <!--><<!--> <!-->0.001) versus 0.95 (<em>P</em> <!--><<!--> <span>0.001). Right ventricle end-diastolic volume (RVEDV) decreased from 107</span> <!-->mL/m<sup>2</sup> [IQR: 75; 138] to 87 [IQR: 67; 115.0] mL/m<sup>2</sup> (<em>P</em> <!-->=<!--> <span>0.039). There was no change in native T1 mapping. We found no non-ischemic late gadolinium enhancement. At 12</span> <span>months, 67% of CMR patients presented with NYHA class I/II and KCCQ overall summery score increased from baseline 46 [IQR: 30.0; 49.1] to 66 [IQR: 57.4; 73.9] (</span><em>P</em> <!-->=<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>TR TEER led to encouraging reverse remodeling of the left ventricle<span>, combining a large increase in LVEF, cardiac output and LV stroke volumes. As we found no changes in myocardial fibrosis, our results suggest a tight interdependence between both ventricles and question the role played by the RV on left ventricular efficiency. Outcomes were consistent with clinical amelioration.</span></p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":\"15 3\",\"pages\":\"Page 269\"},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001933\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001933","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Cardiac remodeling after tricuspid transcatheter edge-to-edge repair: From the right to the left ventricle
Introduction
The management of isolated functional tricuspid regurgitation (TR) is under ongoing investigations as recent interventional breakthrough, such as transcatheter edge-to-edge repair (TEER). We aimed to assess whether and how such device would affect right and left reverse remodeling over time.
Method
This is a monocentric, prospective cohort of 10 consecutive patients treated by TEER between 2019 and 2022 who underwent successive cardiac magnetic resonance. Clinical and echocardiographic follow-up was performed up to 12 months after intervention.
Results
Overall patients were 81 [IQR: 77.5; 84.0] years old and 6 (60%) were women. TTE derived TR was reduced to stage moderate or less in 80% patients (n = 8) at discharge (P < 0.001) and in 77% (n = 7) at 1 year (P < 0.001) compared with 0% at baseline. CMR-derived Left ventricular ejection fraction (LVEF) and left cardiac output improved from 45 [IQR: 40; 56]% to 57 [IQR: 47; 57]% (P = 0.019) and from 2.6 [IQR: 2.1; 2.9] L/min/m2 to 3.1 [IQR: 2.6; 3.7] L/min/m2 (P = 0.020). The interobserver reliability of LVEF before and after TEER was r2 = 0.95 (P < 0.001) versus 0.95 (P < 0.001). Right ventricle end-diastolic volume (RVEDV) decreased from 107 mL/m2 [IQR: 75; 138] to 87 [IQR: 67; 115.0] mL/m2 (P = 0.039). There was no change in native T1 mapping. We found no non-ischemic late gadolinium enhancement. At 12months, 67% of CMR patients presented with NYHA class I/II and KCCQ overall summery score increased from baseline 46 [IQR: 30.0; 49.1] to 66 [IQR: 57.4; 73.9] (P = 0.001).
Conclusion
TR TEER led to encouraging reverse remodeling of the left ventricle, combining a large increase in LVEF, cardiac output and LV stroke volumes. As we found no changes in myocardial fibrosis, our results suggest a tight interdependence between both ventricles and question the role played by the RV on left ventricular efficiency. Outcomes were consistent with clinical amelioration.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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