The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.
The need for a new tricuspid regurgitation grading scheme
Abstract
The adverse effects of severe tricuspid regurgitation (TR) on long-term outcomes has now been reported in a number of natural history studies.1,2 Current treatment for TR is primarily with optimal medical therapy involving diuretics, or surgery.3 Surgical mortality for isolated tricuspid valve interventions however, remains higher than for any other single valve surgery.4,5 Despite the low risk of added tricuspid repair at the time of the left-sided disease surgery,6 and the current guideline recommendation to intervene with annular dilation even in the absence of severe TR,3,7 combined left and right heart valve surgery remains underutilized. In addition, as more left-sided valve disease is treated with transcatheter therapies, the negative impact of TR on survival in these patients has underscored the importance of developing transcatheter solutions to this disease.8,9 Echocardiography remains the primary imaging modality to diagnose the aetiology and severity of the disease once patients are referred.3,10 A vena contracta ≥0.7 cm, effective regurgitant orifice area (EROA) of ≥0.40 cm2, and regurgitant volume ≥45 mL, qualify as severe.11 Despite guidelines advocating a multi-parametric and semi-quantitative or quantitative approach,11,12 most clinicians continue to use qualitative parameters, contributing to the significant underdiagnosis of severe disease. Late in the natural history of the disease, patients fail to respond to diuretics and present with signs of severe right heart failure and low flow. These end-stage patients may have what has been referred to as ‘massive’ TR,12 however even this term fails to capture the severity of regurgitation in patients currently being treated in early feasibility trials of transcatheter devices.13 The SCOUT (Percutaneous Tricuspid Valve Annuloplasty System for Symptomatic Chronic Functional Tricuspid Regurgitation) trial found on average, a reduction in quantitative effective regurgitant orifice area (EROA) of −0.22 ± 0.29 mm2 (the equivalent of a full grade). However the baseline quantitative EROA was 0.85 ± 0.22 mm2 and the resulting EROA was 0.63 ± 0.29 mm2. The current grading schemes for TR thus fail to take into account the ‘torrential’ nature of TR in the patients currently enrolling in these trials. Despite reducing the TR severity from ‘severe TR’ to ‘severe TR’, the SCOUT trial showed that the equivalent quantitative reduction of a ‘grade’ of TR was associated with an increase in forward stroke volume, and resulted in significant improvements in quality of life measures. Although long-term outcomes related to transcatheter reductions in TR are not yet available, natural history studies would suggest that any reduction in TR severity may be associated with a decrease in mortality. It thus seems reasonable to think that not all ‘severe’ grades of TR will have the same in prognosis and defining these grades will be important in determining outcomes in future trials.
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Citations
Cites
Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation
Zoghbi, W. A., Adams, D., Bonow, R. O., Enriquez-Sarano, M., Foster, E., Grayburn, P. A., Hahn, R. T., Han, Y., Hung, J., Lang, R. M., et al. (2017) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2017.01.007 · Cited by 3,556
Self-citation2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.02.536 · Cited by 3,523
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000031 · Cited by 2,905
Guidelines on the management of valvular heart disease (version 2012)
Authors/Task Force Members, Vahanian, A., Alfieri, O., Andreotti, F., Antunes, M. J., Barón-Esquivias, G., Baumgartner, H., Borger, M. A., Carrel, T. P., De Bonis, M., et al. (2012) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezs455 · Cited by 2,009
Self-citationImpact of tricuspid regurgitation on long-term survival
Nath, J., Foster, E., & Heidenreich, P. A. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.09.036 · Cited by 1,677
Lancellotti, P., Moura, L., Pierard, L. A., Agricola, E., Popescu, B. A., Tribouilloy, C., Hagendorff, A., Monin, J. L., Badano, L., Zamorano, J. L., et al. (2010) · European Journal of Echocardiography · doi:10.1093/ejechocard/jeq031 · Cited by 1,545
Self-citationStone, G. W., Adams, D. H., Abraham, W. T., Kappetein, A. P., Généreux, P., Vranckx, P., Mehran, R., Kuck, K.-H., Leon, M. B., Piazza, N., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.05.049 · Cited by 594
Kilic, A., Saha-Chaudhuri, P., Rankin, J. S., & Conte, J. V. (2013) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2013.06.031 · Cited by 301
Early Feasibility Study of a Transcatheter Tricuspid Valve Annuloplasty
Hahn, R. T., Meduri, C. U., Davidson, C. J., Lim, S., Nazif, T. M., Ricciardi, M. J., Rajagopal, V., Ailawadi, G., Vannan, M. A., Thomas, J. D., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.01.054 · Cited by 281
Self-citationTranscatheter Therapies for Treating Tricuspid Regurgitation
Rodés-Cabau, J., Hahn, R. T., Latib, A., Laule, M., Lauten, A., Maisano, F., Schofer, J., Campelo-Parada, F., Puri, R., & Vahanian, A. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.01.063 · Cited by 212
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Cited by
2021 ESC/EACTS Guidelines for the management of valvular heart disease
Vahanian, A., Beyersdorf, F., Praz, F., Milojevic, M., Baldus, S., Bauersachs, J., Capodanno, D., Conradi, L., De Bonis, M., De Paulis, R., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehab395 · Cited by 5,685
Self-citationOtto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000923 · Cited by 3,686
2021 ESC/EACTS Guidelines for the management of valvular heart disease
Beyersdorf, F., Vahanian, A., Milojevic, M., Praz, F., Baldus, S., Bauersachs, J., Capodanno, D., Conradi, L., De Bonis, M., De Paulis, R., et al. (2021) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezab389 · Cited by 622
Self-citationLancellotti, P., Pibarot, P., Chambers, J., La Canna, G., Pepi, M., Dulgheru, R., Dweck, M., Delgado, V., Garbi, M., Vannan, M. A., et al. (2022) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeab253 · Cited by 474
Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation
Axtell, A. L., Bhambhani, V., Moonsamy, P., Healy, E. W., Picard, M. H., Sundt, T. M., & Wasfy, J. H. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.04.028 · Cited by 312
Metadata
- Authors
- Hahn, R. T., & Zamorano, J. L.
- Venue
- European Heart Journal - Cardiovascular Imaging
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-07-13
- Volume
- 18
- Issue
- 12
- Pages
- 1342-1343
- ISSN
- 2047-2404 (ISSN-L)
- 2047-2412
- OpenAlex
- W2735825255
- Cited by
- 574
- References
- 13
- FWCI
- 19.57
- Type
- journal article
- Language
- en
- Open access
- closed
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