Eustachio Agricola1, Giacomo Ingallina1, Massimo Slavich1, Vincenzo Tufaro1, Luigi Badano2, Michele Oppizzi1, Andrea Fisicaro1, Alberto Margonato1
1Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Milan, 2Department of Cardiac, Vascular and Thoracic Sciences, University of Padua, Padua, Italy
Background and aim of the study: The study aim was to evaluate whether, in patients with severe mitral regurgitation (MR), tricuspid valve remodeling was independent of the degree of functional tricuspid regurgitation (FTR) present. Whether any differences in the analysis remodelling, as assessed by two-dimensional (2D) and three-dimensional (3D) echocardiography, can be demonstrated was also addressed.
Methods: A total of 188 patients (mean age 63.5 ± 16.0 years) with severe organic or functional MR with or without associated FTR, and 30 normal controls (mean age 59.2 ± 15 years) were enrolled in the study. Subsequently, both 2D and 3D transthoracic anatomic and functional parameters of the tricuspid valve were analyzed.
Results: Patients and controls differed in all 2D and 3D parameters of tricuspid valve remodelling, except for the 2D end-diastolic annular diameter and circularity indices. The patients were then allocated to either group A (trivial/mild FTR) or group B (moderate/severe FTR).
Significant differences were identified between groups A and B compared to controls in all tricuspid valve remodelling indices, except for the diastolic 2D annular diameter and circularity indices. Groups A and B had similar 2D and 3D parameters of tricuspid valve remodelling. The right ventricular end-diastolic diameter (RVEDD) (β = 0.24, 95% CI: 0.11 to 0.22, p = 0.02) and fractional area change (β = -0.48, 95% CI: -0.24 to 0.09, p = 0.0001, R2 = 0.22) were independent predictors of the tenting area, whereas the RVEDD was the only independent predictor of the diastolic 3D tricuspid annular area (β = 0.53, 95% CI: 1.2 to 2.7, p = 0.0001, R2 = 0.28).
Conclusion: In patients with severe MR, tricuspid valve remodelling was also demonstrated in those with trivial/mild FTR, but was better characterized by 3D echocardiography. Tricuspid valve remodelling and right ventricular dilation were the main determinants of tricuspid valve regurgitation.
The Journal of Heart Valve Disease 2014;23:200-208
|Evidence of Tricuspid Valve Remodelling in Patients with Severe Mitral Regurgitation Independently of Degree of Functional Tricuspid Regurgitation: A Two- and Three-Dimensional Echocardiographic Study|
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