We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Predictors of residual tricuspid regurgitation after percutaneous closure of atrial septal defect.
- Authors
Nassif, Martina; van der Kley, Frank; Abdelghani, Mohammad; Kalkman, Deborah N; Bruin-Bon, Rianne H A C M de; Bouma, Berto J; Schalij, Martin J; Koolbergen, David R; Tijssen, Jan G P; Mulder, Barbara J M; Winter, Robbert J de
- Abstract
Aims Functional tricuspid regurgitation (TR) associated with atrial septal defects (ASDs) is frequently present due to right-sided volume-overload. Tricuspid valve (TV) repair is often considered in candidates for surgical ASD closure, and percutaneous TV repair is currently under clinical investigation. In this study, we develop a prediction model to identify patients with residual moderate/severe TR after percutaneous ASD closure. Methods and results In this observational study, 172 adult patients (26% male, age 49 ± 17 years) with successful percutaneous ASD closure had pre- and post-procedural echocardiography. Right heart dimensions/function were measured. TR was assessed semi-quantitatively. A prediction model for 6-month post-procedural moderate/severe TR was derived from uni-and multi-variable logistic regression. Clinical follow-up (FU) was updated and adverse events were defined as cardiovascular death or hospitalization for heart failure. Pre-procedural TR was present in 130 (76%) patients (moderate/severe: n = 64) of which 72 (55%) had ≥1 grade reduction post-closure. Independent predictors of post-procedural moderate/severe TR (n = 36) were age ≥60 years [odds ratio (OR) 2.57; P = 0.095], right atrial end-diastolic area ≥10cm2/m2 (OR 3.36; P = 0.032), right ventricular systolic pressure ≥44 mmHg (OR 6.44; P = 0.001), and tricuspid annular plane systolic excursion ≤2.3 cm (OR 3.29; P = 0.037), producing a model with optimism-corrected C-index = 0.82 (P < 0.001). Sensitivity analysis excluding baseline none/mild TR yielded similar results. Patients with moderate/severe TR at 6-month FU had higher adverse event rates [hazard ratio = 6.2 (95% confidence interval 1.5–26); log-rank P = 0.004] across a median of 45 (30–76) months clinical FU. Conclusion This study shows that parallel to reduction of volume-overload and reverse remodelling after percutaneous ASD closure, TR improved substantially despite significant TR at baseline. Our proposed risk model helps identify ASD patients in whom TR regression is unlikely after successful percutaneous closure.
- Subjects
DISEASE relapse; MORTALITY risk factors; ATRIAL septal defects; BLOOD pressure; CONFIDENCE intervals; ECHOCARDIOGRAPHY; RIGHT heart ventricle; HEART failure; HEART function tests; HOSPITAL care; PATIENT aftercare; MULTIVARIATE analysis; SCIENTIFIC observation; STATISTICS; SURGICAL complications; SURVIVAL; TRICUSPID valve diseases; MULTIPLE regression analysis; SEVERITY of illness index; PREOPERATIVE period; LOG-rank test; ODDS ratio; PERCUTANEOUS coronary intervention; DISEASE complications; PHYSIOLOGY
- Publication
European Heart Journal - Cardiovascular Imaging, 2019, Vol 20, Issue 2, p225
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jey080