European Heart Journal - Cardiovascular Imaging最新文献

Aims: Management of transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) flow groups-high-gradient (HG-AS), classical low-flow low-gradient (cLFLG-AS), and paradoxical low-flow low-gradient (pLFLG-AS)-is debated. Concomitant mitral regurgitation (MR) worsens outcomes, but the influence of MR aetiology on AS subtypes is unclear. This study aims to evaluate the impact of MR aetiology and severity on outcomes across AS flow groups in TAVR patients.

Methods and results: A retrospective analysis was performed on 2658 patients undergoing TAVR (2013-21). MR was categorized as atrial functional (aFMR), ventricular functional (vFMR), or primary MR (PMR). Outcomes included 3-year mortality, MR improvement, and symptomatic benefit. Out of 2658 TAVR patients, 531 (20.0%) showed at least moderate MR (MR ≥ 2+) (50.1% male, median age 83.1 years). The fraction of patients with MR ≥ 2+ was highest among cLFLG-AS patients (34.2%). MR aetiology varied among AS subtypes, with mostly vFMR in cLFLG-AS (83.0%) and highest rates of aFMR (43%) and PMR (45%) in pLFLG-AS patients. Three-year mortality was significantly affected by MR severity [hazard ratio (HR) for MR2+ vs. MR < 2 1.62 (1.38-1.90)]. Differences in 3-year mortality were found in high-gradient (HG)-AS [HR 1.52 (1.16-1.98)] and pLFLG-AS patients [HR 1.73 (1.24-2.40)], but not in cLFLG-AS patients [HR 1.21 (0.93-1.56)]. MR improvement after TAVR was commonly found in HG-AS (67.2%) and least often among pLFLG-AS (48.7%, P = 0.03 compared with HG-AS). While MR improvement was associated with a lower mortality in HG-AS [HR 0.21 (0.10-0.43)] and cLFLG-AS patients [HR 0.48 (0.29-0.79)], this was not the case in pLFLG-AS patients [1.32 (0.67-2.59)].

Conclusion: MR aetiology and severity influence outcomes after TAVR depending on AS flow groups.

Background: Post-capillary pulmonary hypertension (pcPH) is a frequent complication of heart failure (HF), associated with poor outcomes. While right heart catheterization (RHC) is the diagnostic gold standard, echocardiographic indices such as left atrial volume index (LAVI) and the TAPSE/PASP ratio may offer non-invasive prognostic value.

Objectives: To assess the prognostic utility of LAVI and TAPSE/PASP compared with invasive haemodynamic parameters in patients with HF and pcPH undergoing RHC.

Methods: The PH-HF study is a prospective multicentre cohort of adults with chronic HF and confirmed pcPH (mPAP > 20 mmHg and PAWP > 15 mmHg) enrolled across 13 French centres (2012-2018). Patients with precapillary PH or severe pulmonary/renal comorbidities were excluded. The primary outcome was a 3-year composite of all-cause mortality, urgent heart transplantation or LVAD, or unplanned HF hospitalization. Cox regression was used for survival analyses.

Results: Overall, 55% of patients met the composite echocardiographic risk criterion (LAVI > 35 mL/m2; or TAPSE/PASP < 0.40), which was associated with increased risk of adverse events (HR 1.97, 95% CI 1.41-2.75; p < 0.0001). Results were consistent across HFrEF and HFpEF phenotypes. In a multivariable model including the MAGGIC score, both the echocardiographic criterion and the clinical score remained independently associated with outcomes, supporting their complementary value in risk stratification.

Conclusion: LAVI and TAPSE/PASP are strong, non-invasive predictors of adverse outcomes in HF with pcPH and may enhance prognostic assessment beyond invasive haemodynamics and clinical scores.

Aims: Quantitative methods for tricuspid regurgitation (TR) severity assessment are insufficiently validated. This study aims to assess cardiac magnetic resonance (CMR) quantitation of TR severity and its association with clinical and physiological consequences.

Methods and results: Patients with prospective comprehensive CMR with TR assessment including regurgitant volume and fraction (TRF) were retrospectively identified. Comprehensive clinical, echocardiographic, and laboratory data were collected to assess other markers of TR severity and of TR-related heart-failure (HF), right-sided volumetric characteristics, and prognostic markers. A total of 335 patients were included presenting with a wide range of TR severity [median TRF 21% (13-33%)]. The number of guideline-based echocardiographic signs of severe TR was strongly associated with TRF (P < 0.001). TRF was significantly associated with subjective/objective signs of right-sided HF, including biomarkers of liver dysfunction and CMR-based liver extracellular volume [L-ECV, 36% (32-39%) for TRF > 40%, 31% (28-34%) for TRF 21-40% and 27% (26-30%) for TRF ≤ 20%, P < 0.001]. TRF was associated with maladaptive right-sided remodelling, including right ventricular end-diastolic volume-indexed [RV-EDVi, 117 mL/m2 (99-135 mL/m2) for T-RF > 40%, 98 mL/m2 (79-118 mL/m2)] for TRF 21-40% and 85 mL/m2 (73-103 mL/m2) for TRF ≤ 20%, P < 0.001]. TRF was also strongly associated with prognostic markers of outcomes in TR including TAPSE/PASP ratio [0.38 (0.32-0.46) for TRF > 40%, 0.53 (0.34-0.68) for TRF 21-40% and 0.69 (0.52-0.87) for TRF ≤ 20%, P < 0.001) and the TRISCORE [5 (3-7) for TRF > 40%, 2 (1-3) for TRF 21-40% and 1 (0-2) for TRF ≤ 20%, P < 0.001).

Conclusion: In this all-comers TR cohort, CMR quantification of TR using TRF associated with guideline-based criteria for echocardiographic diagnosis of severe TR. RV remodelling objective right-sided HF signs/symptoms already occurred at TRF thresholds ≥20%, supporting the physiological consequences.