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Tricuspid regurgitation (TR) is a known complication of cardiac implantable electrical devices (CIEDs), with prevalences ranging from 10% to as high as 30%. Despite left bundle branch area pacing (LBBAP) has emerged as an alternative to the limits of His‐bundle pacing (HBP), the long‐term safety of this procedure, notably the worsening of TR after implantation, has yet to be thoroughly investigated. This meta‐analysis sought to determine the frequency of post‐LBBAP TR deterioration and identify the predictors, particularly the distance between lead‐implanted site and the tricuspid valve annulus (lead‐TA‐distance). A systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that reported the incidence of deterioration and measurement of TR grade at baseline and follow‐up following LBBAP, in addition to the differences in exposure between short and long lead‐TA‐distances. A total of three studies involving 480 participants were included in this meta‐analysis. The incidence of TR deterioration was 22%. Patients with TR deterioration also demonstrated a significantly shorter lead‐TA‐distance in comparison to the opposing group (MD: −5.74 mm (−0.70, −10.78); p <.001; I2 = 92.6%). The pooled results of three comparative studies suggest that participants in the longer lead‐TA‐distance group had a significant decrement in the likelihood of TR worsening (adjusted OR = 0.59 (0.36–0.96); p =.034; I2 = 79%). Multivariate analysis conducted in each of the included investigations supported the independence of the connection between lead‐TA‐distance and TR deterioration. A shorter lead‐TA‐distance was an independent risk factor for TR deterioration in individuals with post‐LBBAP implantation. [ABSTRACT FROM AUTHOR]

Introduction: This case report highlights the novel role of His‐bundle pacing (HBP) from right atrium, not just for preserving cardiac function, but also for avoiding interference with TriClip devices. Methods and Results: A 78‐year‐old female with severe tricuspid regurgitation received two TriClip devices. Postprocedure, frequent significant sinus pauses required a pacemaker. HBP was chosen to avoid lead complications. Under local anesthesia, a His pacing lead was inserted via the axillary vein using specialized catheter. Follow‐ups over 2.5 years showed stable parameters with no complications. Conclusion: HBP is effective for patients with TriClip devices, ensuring optimal cardiac function and lead stability. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function–a key prognostic factor in TR–remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion Secondary tricuspid regurgitation (TR) is associated with poor prognosis in acute decompensated heart failure (ADHF). However, its dynamic evolution in response to volume status and treatment has never been previously investigated. In this study, we sought to explore the in‐hospital evolution of TR in ADHF patients and to assess its prognostic implications.We retrospectively enrolled patients admitted for ADHF with ≥2 in‐hospital echocardiographic evaluations of TR. Patients were categorized, according to TR evolution, into persistent moderate‐severe TR, improved TR (from moderate‐severe to trivial‐mild) and persistent trivial‐mild TR. The primary endpoint was a composite of 5‐year all‐cause mortality and heart failure hospitalization (HFH). A total of 1054 patients were included. Of 318 patients (30%) with moderate‐severe TR at admission, 49% improved TR severity and showed better trends of decongestion, whereas those who maintained persistent moderate‐severe TR had characteristics of more severe heart failure at admission and discharge. Atrial fibrillation, previous heart failure and higher dosage of loop diuretics before admission were associated with a lower probability of improved TR. After adjustment, improved TR was associated with lower risk of 5‐year all‐cause mortality/HFH compared with persistent moderate‐severe TR (hazard ratio [HR] 0.524, p = 0.008) and no different from persistent trivial‐mild TR (HR 0.878, p = 0.575). Results were consistent across all subgroups of in‐hospital variation of mitral regurgitation.Among ADHF patients with moderate‐severe TR at admission, 49% had an in‐hospital improvement in TR severity, which was associated with a reduction in risk of 5‐year all‐cause mortality and morbidity outcomes. [ABSTRACT FROM AUTHOR]

Aims: Data on the prognostic impact of residual tricuspid regurgitation (TR) after tricuspid transcatheter edge‐to‐edge repair (T‐TEER) are scarce. The aim of this analysis was to evaluate 2‐year survival and symptomatic outcomes of patients in relation to residual TR after T‐TEER. Methods and results: Using the large European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR registry) we investigated the impact of residual TR on 2‐year all‐cause mortality and New York Heart Association (NYHA) functional class at follow‐up. The study further identified predictors for residual TR ≥3+ using a logistic regression model. The study included a total of 1286 T‐TEER patients (mean age 78.0 ± 8.9 years, 53.6% female). TR was successfully reduced to ≤1+ in 42.4%, 2+ in 40.0% and 3+ in 14.9% of patients at discharge, while 2.8% remained with TR ≥4+ after the procedure. Residual TR ≥3+ was an independent multivariable predictor of 2‐year all‐cause mortality (hazard ratio 2.06, 95% confidence interval 1.30–3.26, p = 0.002). The prevalence of residual TR ≥3+ was four times higher in patients with higher baseline TR (vena contracta >11.1 mm) and more severe tricuspid valve tenting (tenting area >1.92 cm2). Of note, no survival difference was observed in patients with residual TR ≤1+ versus 2+ (76.2% vs. 73.1%, p = 0.461). The rate of NYHA functional class ≥III at follow‐up was significantly higher in patients with residual TR ≥3+ (52.4% vs. 40.5%, p < 0.001). Of note, the degree of TR reduction significantly correlated with the extent of symptomatic improvement (p = 0.012). Conclusions: T‐TEER effectively reduced TR severity in the majority of patients. While residual TR ≥3+ was associated with worse outcomes, no differences were observed for residual TR 1+ versus 2+. Symptomatic improvement correlated with the degree of TR reduction. [ABSTRACT FROM AUTHOR]

Aim: Severe functional tricuspid regurgitation (FTR) is associated with high risk of cardiovascular events, particularly heart failure (HF) and mortality. MicroRNAs (miRNAs) have been recently identified as novel biomarkers in different cardiovascular conditions, but no studies have focused on FTR. We sought to (1) to identify and validate circulating miRNAs as regulators of FTR and (2) to test association of miRNA with heart failure and mortality in FTR. Methods and results: Consecutive patients with isolated severe FTR (n = 100) evaluated in the outpatient Heart Valve Clinic and age‐ and gender‐matched subjects with no TR (controls, n = 50) were prospectively recruited. The experimental design included (1) a screening phase to identify candidate miRNA differentially expressed in FTR (n = 8) compared with controls (n = 8) through miRNA array profiling of 192 miRNAs using quantitative reverse transcription PCR arrays [qRT‐PCR]) and (2) a validation phase in which candidate miRNAs identified in the initial screening were selected for further validation by qRT‐PCR in a prospectively recruited cohort of FTR (n = 92) and controls (n = 42). Bioinformatics analysis was used to predict their potential target genes and functional pathways elicited. A combined endpoint of hospital admission due to heart failure (HF) and all‐cause mortality was defined. Initial screening identified 16 differentially expressed miRNAs in FTR compared with controls, subsequently confirmed in the validation phase (n = 16 were excluded due to significant haemolysis). miR‐186‐5p, miR‐30e‐5p, and miR‐152‐3p identified FTR with high predictive value [AUC of 0.93 (0.88–0.97), 0.83 (0.75–0.91) and 0.84 (0.76–0.92), respectively]. During a median follow‐up of 20.4 months (IQR 8–35 months), 32% of FTR patients reached the combined endpoint. Patients with low relative expression of miR‐15a‐5p, miR‐92a‐3p, miR101‐3p, and miR‐363‐3p, miR‐324‐3p, and miR‐22‐3p showed significantly higher rates of events (log‐rank test for all P < 0.01). Both miR‐15a‐5p [hazard ratio: 0.21 (0.06–0.649, P = 0.007) and miR‐92a‐3p (0.27 (0.09–0.76), P = 0.01] were associated with outcomes after adjusting for age, gender, and New York Heart Association functional class. Conclusions: Circulating miRNAs are novel diagnostic and prognostic biomarkers in severe FTR. The quantification of miR‐186‐5p, miR‐30e‐5p, and miR‐152‐3p held strong diagnostic value, and the quantification of miR‐15a‐5p and miR‐92a‐3p are independently associated with outcomes. The recognition of specific miRNAs offers a novel perspective for TR evaluation. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiography (TEE) is primarily used to guide transcatheter structural heart interventions, such as tricuspid transcatheter edge‐to‐edge repair (TEER). Although TEE has a good safety profile, it is still an invasive imaging technique that may be associated with complications, especially when performed during long transcatheter procedures or on frail patients. The aim of this study was to assess TEE‐related complications during tricuspid TEER. Methods: This is a prospective study enrolling 53 patients who underwent tricuspid TEER for severe tricuspid regurgitation (TR). TEE‐related complications were assessed clinically and divided into major (life‐threatening, major bleeding requiring transfusions or surgery, organ perforation, and persistent dysphagia) and minor (perioral hypesthesia, < 24 h dysphagia/odynophagia, minor intraoral bleeding and hematemesis not requiring transfusion) Results: The median age of the patient population was 79 years; 43.4% had severe, 39.6% massive, and 17.6% torrential TR. 62.3% of patients suffered from upper gastrointestinal disorders. Acute procedural success (APS) was achieved in 88.7% in a median device time of 36 min. A negative association was shown between APS and lead‐induced etiology (r = ‐.284, p =.040), baseline TR grade (r = ‐.410, p =.002), suboptimal TEE view (r = ‐.349, p =.012), device time (r = ‐.234, p =.043), and leaflet detachment (r = ‐.496, p <.0001). We did not observe any clinical manifest major or minor TEE‐related complications during the hospitalization. Conclusions: Our study reinforces the good safety profile and efficacy of TEE guidance during tricuspid TEER. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious complications. Furthermore, suboptimal intraprocedural TEE views are associated with lower TR reduction rates. Highlights: Transesophageal echocardiography is a crucial and safe technique for guiding transcatheter structural heart interventions.A mix of mid/deep esophageal and trans gastric views, as well as real‐time 3D imaging is generally used to guide the procedure.Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious problems.A shorter device time is associated with more rarely probe‐related complications.Suboptimal intraprocedural TEE views are associated with lower TR reduction rates. [ABSTRACT FROM AUTHOR]

Purpose: There is currently limited information on the utility of transthoracic echocardiography (TTE)‐derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction. Methods: We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n = 61), regurgitant (n = 24), or stenotic (n = 15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction. Results: The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of >2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio > 3.2, mean gradient (MGTV) > 6.2 mmHg and pressure half‐time > 218 ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio > 2.8 (OR = 9.00, 95% CI = 2.13–41.61, p =.003) and MGTV > 5.1 mmHg (OR = 6.50, 95% CI = 1.69–27.78, p =.008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%–92.2% of normal and 62.5%–96.0% of dysfunctional BTV were identified. Conclusions: Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio > 2.8 and MGTV > 5.1 mmHg, to assess the need for additional testing with TEE. [ABSTRACT FROM AUTHOR]

Introduction: Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. Methods and Results: We present the first documented case of lead failure following TricValve® implantation, a dedicated self‐expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. Conclusion: The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead‐induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing‐induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre‐existing TR have not been consistent predictors of CIED‐induced TR. While two‐ dimensional echocardiography is helpful in assessing the severity of TR, three‐dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three‐dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED‐induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. Methods: We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0 = none/trivial, 1 = mild, 2 = moderate, 3 = severe). A change of >1 grade following extraction was considered significant. Results: A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference on average TR grade pre‐ and postextraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p = 0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e., >1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR postextraction (44.0% vs. 31.6%, p = 0.04). Conclusion: In our single‐center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction. [ABSTRACT FROM AUTHOR]

Background: According to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large‐scale studies reporting the data about long‐term lead stability in patients with severe tricuspid regurgitation. Methods and Results: We present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP. Conclusions: We concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP. [ABSTRACT FROM AUTHOR]

Aims: While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)‐related right‐ heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. Methods and results: Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76–83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2‐year mortality on Cox regression analyses with Youden index‐derived cut‐offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre‐interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left‐sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right‐sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right‐sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. Conclusion: In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right‐sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre‐interventional reduction of right‐sided congestion can improve outcomes after TTVI should be established in dedicated studies. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to assess the pathophysiological implications of severe tricuspid regurgitation (TR) in patients with heart failure with preserved ejection fraction (HFpEF) by using tricuspid transcatheter edge‐to‐edge repair (T‐TEER) as a model of right ventricular (RV) volume overload relief. Methods and results: This prospective interventional single arm trial (NCT04782908) included patients with invasively diagnosed HFpEF. The following parameters were prospectively assessed before and after T‐TEER: left ventricular (LV) diastolic properties by invasive pressure–volume loop recordings; biventricular time–volume curves and function as well as septal curvature by cardiac magnetic resonance imaging; strain analyses for timing of septal motion. Overall, 20 patients (median age 78, interquartile range [IQR] 72–83 years, 65% female) were included. T‐TEER reduced TR by a median of 2 (of 5) grades (IQR 2–1). T‐TEER increased LV stroke volume and LV end‐diastolic volume (LVEDV) (p < 0.001), without increasing LV end‐diastolic pressure (LVEDP) (p = 0.094), consequently diastolic function improved with a reduction in LVEDP/LVEDV (p = 0.001) and a rightward shift of the end‐diastolic pressure–volume relationship. The increase in LVEDV correlated with a decrease in RV end‐diastolic volume (p < 0.001) and LV transmural pressure increased (p = 0.028). Secondary to a decrease in early RV filling, improvements in early LV filling were observed, correlating with an alleviation of leftwards bowing of the septum (p < 0.01, respectively). Conclusion: Diastolic LV properties in patients with HFpEF and severe TR are importantly determined by ventricular interaction in the setting of RV volume overload. T‐TEER reduces RV volume overload and improves biventricular interaction and physiology. [ABSTRACT FROM AUTHOR]

Aims: Prognostic impact of post‐procedural changes in right ventricular (RV) function after tricuspid transcatheter edge‐to‐edge repair (T‐TEER) is still unclear. We investigated association of RV function and its post‐procedural changes with clinical outcomes in patients undergoing T‐TEER. Methods and results: We retrospectively analysed 204 patients who underwent T‐TEER and echocardiographic follow‐up at 3 months after T‐TEER. RV function was assessed by RV fractional area change (RVFAC), and RV dysfunction was defined as RVFAC <35%. Patients with an increase in RVFAC from baseline to the follow‐up were considered as RV responders. Patients were divided into four groups according to baseline RVFAC and the RV responder. The primary outcome was a composite of mortality and hospitalization due to heart failure within 1 year. Forty‐five of 204 patients (22.1%) had RVFAC <35% at baseline, and 71 (34.8%) were RV responders. The association between the RV responder and the composite outcome had a significant interaction with RVFAC at baseline. Among patients with baseline RVFAC <35%, RV responders had a lower risk of the composite outcome than RV non‐responders, while this association was not significant in those with baseline RVFAC ≥35%. Among patients with baseline RVFAC <35%, a smaller RV diameter and a greater reduction of tricuspid regurgitation were predictors for the RV responder. Conclusion: Post‐procedural increase in RVFAC after T‐TEER is associated with improved outcomes in patients with RV dysfunction. The factors related to the increase in RVFAC may support patient selection for T‐TEER in patients with RV dysfunction. [ABSTRACT FROM AUTHOR]

Aims: Tricuspid regurgitation (TR) is commonly observed in patients with severe left‐sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population. Methods and results: Among 6883 patients with severe native left‐sided VHD or previous left‐sided valvular intervention enrolled in the EURObservational Research Programme prospective VHD II survey, moderate or severe TR was very frequent in patients with severe mitral VHD (30% when mitral stenosis, 36% when mitral regurgitation [MR]), especially in patients with secondary MR (46%), and rare in patients with severe aortic VHD (4% when aortic stenosis, 3% when aortic regurgitation). An increase in TR grade was associated with a more severe clinical presentation and a poorer 6‐month survival (p < 0.0001). Rates of concomitant tricuspid valve (TV) intervention at the time of left‐sided heart valve surgery were high at the time of mitral valve surgery (50% when mitral stenosis, 41% when MR). Concordance between class I indications (patients with severe TR) for concomitant TV surgery at the time of left‐sided valvular heart surgery according to guidelines and real‐practice decision‐making was very good (88% overall, 95% in patients operated on for MR). Conclusion: In this large international prospective survey among patients with severe left‐sided VHD, moderate/severe TR was frequent in patients with mitral valve disease and was associated with a poorer outcome as TR grade increased. In patients with severe TR, compliance to guidelines for class I indications for concomitant TV surgery at the time of left‐sided heart valve surgery was very good. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency catheter ablation (RFCA) is an effective method for controlling the heart rate of paroxysmal atrial fibrillation (PAF). However, recurrence is trouble under the RFCA. To gain a deeper understanding of the risk factors for recurrence in patients, we created a nomogram model to provide clinicians with treatment recommendations. Methods: A total of two hundred thirty‐three patients with PAF treated with RFCA at Guizhou Medical University Hospital between January 2021 and December 2022 were consecutively included in this study, and after 1 year of follow‐up coverage, 166 patients met the nadir inclusion criteria. Patients with AF were divided into an AF recurrence group and a non‐recurrence group. The nomogram was constructed using univariate and multivariate logistic regression analyses. By calculating the area under the curve, we analyzed the predictive ability of the risk scores (AUC). In addition, the performance of the nomogram in terms of calibration, discrimination, and clinical utility was evaluated. Results: At the 12‐month follow‐up, 48 patients (28.92%) experienced a recurrence of AF after RFCA, while 118 patients (71.08%) maintained a sinus rhythm. In addition to age, sex, and TRV, LAD, and TTPG were independent predictors of recurrence of RFCA. The c‐index of the nomogram predicted AF recurrence with an accuracy of.723, showing good decision curves and a calibrated nomogram, as determined by internal validation using a bootstrap sample size of 1000. Conclusion: We created a nomogram based on multifactorial logistic regression analysis to estimate the probability of recurrence in patients with atrial fibrillation 1 year after catheter ablation. This plot can be utilized by clinicians to predict the likelihood of recurrence. [ABSTRACT FROM AUTHOR]

Right‐sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right‐sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right‐sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right‐sided heart failure providing practical suggestions for patient identification and management. [ABSTRACT FROM AUTHOR]

Background: Traditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead‐related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function. Methods and Results: Echocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre‐ and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5–97.0). On echocardiogram performed 8.9 months (IQR 4.5–14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p =.64) from pre‐procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p =.0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p =.0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%. Conclusion: We did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function. [ABSTRACT FROM AUTHOR]

Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) in children may be secondary to congenital anomalies of the tricuspid valve complex which is composed by annulus, leaflets, commissures, chordae tendineae, and papillary muscles. The most common congenital cause is Ebstein's anomaly; however, there are less frequent causes such as abnormal number of tricuspid leaflets, tricuspid cleft, leaflet prolapse, double orifice tricuspid valve, and congenital tricuspid valve dysplasia. Identifying the precise cause is important to plan an appropriate repair surgery. In this article, the case of a 4‐year‐old patient with a tetracuspid valve with significant tricuspid regurgitation is presented and the morphological analysis was made by two‐dimensional (2D) and three‐dimensional (3D) transthoracic echocardiography. The morphological differences between a tetracuspid valve and a cleft of the anterior leaflet tricuspid valve are exposed. 3D echocardiographic evaluation of the tricuspid valve allowed a better understanding of the tricuspid valve anatomy, which includes evaluation of the tricuspid annulus, leaflets, commissures, and subvalvular apparatus. Recognizing the accurate cause of isolated tricuspid regurgitation allows better planning of the surgical technique. [ABSTRACT FROM AUTHOR]

Background: Implantable cardioverter‐defibrillators are used globally and are reliable, but complications related to transvenous leads remain a concern. Evidence related to the incidence and costs of those complications is heterogeneous with respect to scope and healthcare system. This analysis aims to create estimates of the incidence and costs of tricuspid valve (TV) complications, lead failures, and lead extractions from a single large real‐world data set. Methods and Results: This retrospective longitudinal cohort study used the deidentified Medicare Fee for Service administrative claims database. A total of 116 036 patients with de novo transvenous ICD implant were analyzed. Mean hospital costs were $26 903 for tricuspid valve complications, $20 851 for lead failures, and $22 278 for lead extractions. Conclusions: Transvenous ICD lead complications incur significant costs to patients, hospitals, and payers when they occur. Advancements in lead technology that reduce these complications could bring significant clinical and economic value. [ABSTRACT FROM AUTHOR]

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a common, effective and reliable treatment modality for portal hypertension. Migration of the TIPS stent into the right atrium is a rare and fatal complication. Case presentation: We report a case of severe tricuspid regurgitation caused by a stent migrating into the right atrium in a patient hospitalized with refractory ascites due to cirrhosis. Discussion: In this case, it is noteworthy that secondary stenting, which is necessary especially in cases of occlusion, significantly increases the risk of migration. Conclusion: Although a rare complication, intracardiac stent migration should be considered in patients with a history of TIPS in the presence of a new heart murmur and signs of arrhythmia. [ABSTRACT FROM AUTHOR]

Reflected pressure waves can impact central aortic pressure, and can cause notching of the pulmonic valve Doppler signal. However, reflected waves in the venous system usually do not achieve a high enough velocity to alter Doppler flow patterns. Herein we report a case of systolic notching of the tricuspid regurgitant signal that likely resulted from reflected venous waves. [ABSTRACT FROM AUTHOR]

Pacer wire induced tricuspid regurgitation is not well‐understood. The mechanisms behind pacer wired induced tricuspid regurgitation have not been clearly defined. This clinical vignette sets to identify different technical mechanisms behind cardiac lead induced tricuspid regurgitation to help optimize cardiac lead implantation strategies for future device implantation. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation is a widely recognised phenomenon in patients with transvenous cardiac rhythm management (CRM) devices. If tricuspid valve repair or replacement is to be considered, what to do with the existing CRM system requires scrutiny with multidisciplinary input. We present a case of multifactorial tricuspid regurgitation in a 48‐year‐old female with giant cell myocarditis and a transvenous implantable cardioverter‐defibrillator (ICD). Key considerations in management and alternative CRM options are discussed. [ABSTRACT FROM AUTHOR]

Aim: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum. Methods and results: The ESC‐HFA EORP HF Long‐Term Registry is a prospective, multicentre, observational study including patients with HF and 1‐year follow‐up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60–0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41–0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36–0.49), and combined MR/TR (OR 0.59; 95% 0.50–0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61–2.33). All‐cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR. Conclusion: In a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome. [ABSTRACT FROM AUTHOR]

Purpose: For assessing the severity of tricuspid regurgitation (TR), there is no gold standard. We developed a parameter, the right ventricular systolic force ratio—RIVIERA, using the continious wave Doppler analysis of TR and pulsed‐wave analysis of the right ventricle outflow tract. We hypothesized that the RIVIERA would facilitate the ability to identify severe TR in clinical settings. Materials and Methods: We obtained data from routine transthoracic echocardiograms. All records reporting no or mild TR (n = 732), moderate TR (n = 584), and severe TR (n = 519) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, the RIVIERA, and right‐sided chamber volumes. Results: Significant linear trends were demonstrated for right atrial volume index, end‐diastolic volume index, RVOT velocity time integral, TR jet area, TR‐Vmax, TR‐VTI, TR acceleration, VC width, EROA with increasing TR severity. Independent predictors of severe RT included RIVIERA <4.8, VC width ≥0.7 cm, TR jet area > 10 cm2, and EROA ≥0.4 cm2. Conclusion: The RIVIERA is a feasible, effective, and independent predictor of severe TR that enhances established techniques for estimating TR severity. For clinical decision‐making and management, accurate measurement and classification of TR severity are essential. Therefore, it should be thought about include the RIVIERA in the integrative method to assessing TR severity. [ABSTRACT FROM AUTHOR]

Introduction: Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). Methods: We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow‐up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one‐grade improvement of TR) and non‐improvement of TR: IM group and Non‐IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all‐cause death) more than 12 months after the RFCA. Results: IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event‐free survival than Non‐IM group. Conclusions: Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes. [ABSTRACT FROM AUTHOR]

Aims: Several studies demonstrated that tricuspid regurgitation (TR) is associated with poor clinical outcomes. However, data on patients with TR who experienced acute heart failure (AHF) remains scarce. The purpose of this study is to evaluate the association between TR and clinical outcomes in patients admitted with AHF, using a large‐scale Japanese AHF registry. Methods and results: The current study population consisted of 3735 hospitalized patients due to AHF in the Kyoto Congestive Heart Failure (KCHF) registry. TR grades were assessed according to the routine clinical practice at each participating centre. We compared the baseline characteristics and outcomes according to the severity of TR. The primary outcome was all‐cause death. The secondary outcome was hospitalization for heart failure (HF). The median age of the entire study population was 80 (interquartile range: 72–86) years. One thousand two hundred five patients (32.3%) had no TR, while mild, moderate, and severe TR was found in 1537 patients (41.2%), 776 patients (20.8%), and 217 patients (5.8%), respectively. Pulmonary hypertension, significant mitral regurgitation, and atrial fibrillation/flutter were strongly associated with the development of moderate/severe of TR, while left ventricular ejection fraction <50% was inversely associated with it. Among 993 patients with moderate/severe TR, the number of patients who underwent surgical intervention for TR within 1 year was only 13 (1.3%). The median follow‐up duration was 475 (interquartile range: 365–653) days with 94.0% follow‐up at 1 year. As the TR severity increased, the cumulative 1 year incidence of all‐cause death and HF admission proportionally increased ([14.8%, 20.3%, 23.4%, 27.0%] and [18.9%, 23.0%, 28.5%, 28.4%] in no, mild, moderate, and severe TR, respectively). Compared with no TR, the adjusted risks of patients with mild, moderate, and severe TR were significant for all‐cause death (hazard ratio [95% confidence interval]: 1.20 [1.00–1.43], P = 0.0498, 1.32 [1.07–1.62], P = 0.009, and 1.35 [1.00–1.83], P = 0.049, respectively), while those were not significant for hospitalization for HF (hazard ratio [95% confidence interval]: 1.16 [0.97–1.38], P = 0.10, 1.19 [0.96–1.46], P = 0.11, and 1.20 [0.87–1.65], P = 0.27, respectively). The higher adjusted HRs of all the TR grades relative to no TR were significant for all‐cause death in patients aged <80 years, but not in patients aged ≥80 years with significant interaction. Conclusions: In a large Japanese AHF population, the grades of TR could successfully stratify the risk of all‐cause death. However, the association of TR with mortality was only modest and attenuated in patients aged 80 or more. Further research is warranted to evaluate how to follow up and manage TR in this elderly population. [ABSTRACT FROM AUTHOR]

Background: Progression to combined post‐ and pre‐capillary pulmonary hypertension (PH) provides prognostic information in human patients with post‐capillary PH. Pulmonary vascular resistance estimated by echocardiography (PVRecho) is useful for the stratification of dogs with myxomatous mitral valve disease (MMVD) and detectable tricuspid regurgitation. Objectives: To evaluate the prognostic value of PVRecho in dogs with MMVD. Animals: Fifty‐four dogs with MMVD and detectable tricuspid regurgitation. Methods: Prospective cohort study. All dogs underwent echocardiography. The PVRecho was calculated based on tricuspid regurgitation and the velocity‐time integral of the pulmonary artery flow. To evaluate the influence of echocardiographic variables on cardiac‐related deaths, Cox proportional hazard analysis was performed. Additionally, Kaplan‐Meier curves classified by PVRecho tertiles were made and compared using log‐rank tests to evaluate the influence of PVRecho on all‐cause mortality and cardiac‐related death. Results: The median follow‐up time was 579 days. Forty‐one dogs with MMVD (PH severity [number]: no or mild, 21/33; moderate, 11/11; severe, 9/10) died during the study. In the multivariable Cox proportional hazard analysis adjusted for age, sildenafil administration, and American College of Veterinary Internal Medicine stage of MMVD, left atrial to aortic diameter ratio and PVRecho remained significant (adjusted hazard ratio [95% confidence interval]: 1.2 [1.1‐1.3] and 2.1 [1.6‐3.0], respectively). Higher PVRecho showed a significant association with lower survival rates. Conclusions and Clinical Importance: Left atrial enlargement and high PVRecho were independent prognostic factors in dogs with MMVD and detectable tricuspid regurgitation. [ABSTRACT FROM AUTHOR]

Aims: Wildtype transthyretin amyloid cardiomyopathy is an under‐recognized cause of heart failure in elderly patients. Transcatheter tricuspid valve repair is a newly emerging therapeutic option for severe tricuspid regurgitation (TR). We present first insights into safety and possible benefits of this procedure in patients with cardiac amyloidosis. Methods and results: Eight patients with cardiac non‐hereditary (wildtype) transthyretin (ATTRwt) amyloidosis and severe to torrential TR, undergoing successful transcatheter tricuspid valve repair, were included in the analysis and compared to a control group of 21 patients without cardiac amyloidosis. All patients presented with an advanced stage of amyloid cardiomyopathy. Primary endpoint was reduction in TR at 3 months follow‐up. Secondary endpoints were feasibility, safety, hospitalization or death, clinical improvement, cardiac biomarkers, and structural and functional right heart parameter obtained by echocardiography. Transcatheter tricuspid valve repair resulted in a significant reduction of TR (IV to II, P = 0.008) in all eight patients with cardiac amyloidosis (100%). Device success (amyloidosis 75% vs. control group 86%, P = 0.597) and overall probability of hospitalization or death (amyloidosis 13% vs. control group 25%, P = 0.646) were similar compared with those in the control group at 3 months follow‐up. Transcatheter tricuspid valve repair led to an improvement of New York Heart Association functional class (P = 0.031) and 6 min walking distance (from 313 ± 118 to 337 ± 106, P = 0.012). TR reduction in amyloidosis patients was less extensive compared with that in control group (TR‐reduction 1.6 ± 0.3, P = 0.008 vs. control group 2.3 ± 0.3, P < 0.0001). Furthermore, these patients showed no significant improvement of structural right heart parameters. Conclusions: Transcatheter tricuspid valve repair is a safe and feasible new treatment option in patients with amyloid cardiomyopathy and has the potential to improve TR‐grade and clinical status. However, the benefit appears to be less pronounced compared with patients without cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

The article explores the impact of cardiac implantable electronic devices (CIEDs) on tricuspid regurgitation (TR) and discusses the challenges in management. Topics discussed include the pathophysiologic mechanisms of CIED-associated TR, imaging methods for assessing TR with a focus on three-dimensional transesophageal echocardiography (3DTEE), and the role of different pacing strategies in mitigating TR severity.

Edge‐to‐edge tricuspid transcatheter repair requires extensive echocardiographic planning before the procedure. Sometimes, anatomic features may anticipate a suboptimal result. For this reason, a tailored strategy is the key to the procedural success. We report a case of massive tricuspid regurgitation due to multiple complex mechanisms that was successfully treated by clipping the antero‐septal commissure to restore functional coaptation of the valve leaflets at multiple sites. [ABSTRACT FROM AUTHOR]

Hedinger Syndrome or carcinoid heart disease is a rare cardiac complication of neuroendocrine tumors (NET) affecting the tricuspid and pulmonary valves. Following is a case description of a patient undergoing treatment for a neuroendocrine tumor with liver metastasis, referred with symptomatic tricuspid valve regurgitation and pulmonary valve stenosis for surgical valve replacement. Planned surgical valve replacement was successfully performed before the onset of severe right ventricular failure or pulmonary hypertension in this case of carcinoid heart disease. An interdisciplinary approach and regular follow up is recommended in such cases. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is an important predictor of poor outcomes in dogs with mitral regurgitation (MR). The feasibility of radiography to predict PH in dogs with MR is unknown. This retrospective, observational, and analytic study aimed to identify a radiographic parameter to predict PH in dogs with MR. A total of 302 dogs diagnosed with MR on echocardiography were enrolled. Medical record and radiographic findings such as the size of the main pulmonary artery, left atrium, left ventricle, and right chamber, and cranial and caudal pulmonary arteries and veins were evaluated according to the presence of PH. The diameters of the cranial and caudal pulmonary vessels were compared to the fourth rib and the ninth rib, respectively, and the ratio of the pulmonary artery to the corresponding vein (CdPA/CdPV) was calculated. Pulmonary hypertension was diagnosed in 77 dogs (25.5%) and the prevalence of PH increased with MR grade. The CdPA/CdPV was significantly higher (P < 0.001) in the presence of PH. Multivariate analysis showed that the CdPA/CdPV was the only independent radiographic parameter that had a significant association with PH in dogs with MR (P = 0.028). The cut‐off value of the CdPA/CdPV = 1.10 showed 90.6% specificity and 31.1% sensitivity for detecting PH in dogs with MR. In dogs with MR, PH can be predicted with high specificity when the caudal pulmonary artery is 1.1 times larger than the corresponding vein on radiographs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate short‐term changes in tricuspid regurgitation (TR) after transcatheter edge‐to‐edge mitral valve repair (M‐TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. Methods and results: This is a retrospective analysis of SMR patients undergoing successful M‐TEER (post‐procedural mitral regurgitation ≤2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40–152) days after M‐TEER, 173 (35%) showed ≥1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR ≤2+ after M‐TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re‐assessment. At a median follow‐up of 590 (IQR 209–1103) days from short‐term echocardiographic re‐assessment, all‐cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log‐rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short‐term follow‐up was associated with lower all‐cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR ≤2+ after M‐TEER was independently associated with a 42% decreased risk of mortality (p = 0.011). Conclusion: More than one third of patients with SMR undergoing successful M‐TEER experienced an improvement in TR. Pre‐procedural TR was not associated with outcome, but a TR ≤2+ at short‐term follow‐up was independently associated with long‐term mortality. Optimal M‐TEER result and a small left atrium were associated with a higher likelihood of TR ≤2+ after M‐TEER. [ABSTRACT FROM AUTHOR]

Aims: Tricuspid regurgitation (TR) is associated with high mortality, morbidity and reduced physical capacity. This study was designed to examine the long‐term impact of transcatheter tricuspid valve intervention (TTVI) on physical activity by using the method of actigraphy. Methods and results: Overall, we prospectively included 128 heart failure patients with severe TR (median age 79 years, 48% female) who were scheduled for TTVI. Patients were equipped with activity tracking devices for 1 week before TTVI, and again at 1–6 months and 1 year after TTVI. We compared continuous physical activity (CPA), defined as the mean number of steps/day with New York Heart Association class, quality of life assessments, and 6‐min walk distance (all p <0.01). TTVI reduced TR to grade ≤2+ in 94% of patients. Median (interquartile range [IQR]) CPA at baseline was 3108 (1350–4959) steps/day, which increased by 31.4% to 3958 (1823–5657) steps/day at 1–6 months and 4080 (2293–6514) steps/day at 1 year after TTVI (p <0.001 for both comparisons). The impact of TTVI was significantly higher in advanced heart failure patients with low baseline activity (baseline CPA <1350 steps/day; 1‐year CPA increase: +121.3%; p <0.001), when compared to moderate activity patients (baseline CPA 1350–4959 steps/day; 1‐year CPA increase: +27.5%; p <0.01) or high activity patients (baseline CPA >4959 steps/day; 1‐year CPA change: +2.6%; p = 0.39). Conclusion: One‐week actigraphy demonstrates durable improvement of physical activity after TTVI. Fragile chronic heart failure patients with very low baseline activity, as determined by actigraphy in this study, significantly benefit from transcatheter intervention and should not be excluded from TTVI. [ABSTRACT FROM AUTHOR]

Introduction: Conventional transvenous pacemaker leads may interfere with the tricuspid valve leaflets, tendinous chords, and papillary muscles, resulting in significant tricuspid valve regurgitation (TR). Leadless pacemakers (LLPMs) theoretically cause less mechanical interference with the tricuspid valve apparatus. However, data on TR after LLPM implantation are sparse and conflicting. Our goal was to investigate the prevalence of significant TR before and after LLPM implantation. Methods: Patients who received a leadless LLPM (Micra™ TPS, Medtronic) between May 2016 and May 2021 at our center were included in this observational study if they had at least a pre‐ and postinterventional echocardiogram (TTE). The evolution of TR severity was assessed. Following a systematic literature review on TR evolution after implantation of a LLPM, data were pooled in a random‐effects meta‐analysis. Results: We included 69 patients (median age 78 years [interquartile range (IQR) 72–84 years], 26% women). Follow‐up duration between baseline and follow‐up TTE was 11.4 months (IQR 3.5–20.1 months). At follow‐up, overall TR severity was not different compared to baseline (p =.49). Six patients (9%) had new significant TR during follow‐up after LLPM implantation, whereas TR severity improved in seven patients (10%). In the systematic review, we identified seven additional articles that investigated the prevalence of significant TR after LLPM implantation. The meta‐analysis based on 297 patients failed to show a difference in significant TR before and after LLPM implantation (risk ratio 1.22, 95% confidence interval 0.97–1.53, p =.11). Conclusion: To date, there is no substantial evidence for a significant change in TR after implantation of a LLPM. [ABSTRACT FROM AUTHOR]

Doppler echocardiography plays a central role in the assessment of pulmonary hypertension (PAH). We aim to improve quality assessment of systolic pulmonary arterial pressure (SPAP) by applying a cubic polynomial interpolation to digitized tricuspid regurgitation (TR) waveforms. Patients with PAH and advanced lung disease were divided into three cohorts: a derivation cohort (n = 44), a validation cohort (n = 71), an outlier cohort (n = 26), and a non‐PAH cohort (n = 44). We digitized TR waveforms and analyzed normalized duration, skewness, kurtosis, and first and second derivatives of pressure. Cubic polynomial interpolation was applied to three physiology‐driven phases: the isovolumic phase, ejection phase, and "shoulder" point phase. Coefficients of determination and a Bland−Altman analysis was used to assess bias between methods. The cubic polynomial interpolation of the TR waveform correlated strongly with expert read right ventricular systolic pressure (RVSP) with R2 > 0.910 in the validation cohort. The biases when compared to invasive SPAP measured within 24 h were 6.03 [4.33; 7.73], −2.94 [1.47; 4.41], and −3.11 [−4.52; −1.71] mmHg, for isovolumic, ejection, and shoulder point interpolations, respectively. In the outlier cohort with more than 30% difference between echocardiographic estimates and invasive SPAP, cubic polynomial interpolation significantly reduced underestimation of RVSP. Cubic polynomial interpolation of the TR waveform based on isovolumic or early ejection phase may improve RVSP estimates. [ABSTRACT FROM AUTHOR]

Background: Adolescents and adults with native Ebstein's anomaly (EA) are at the benign part of the Ebstein spectrum, having survived infancy without surgery. In this population, surgical indication and timing remain objects of controversy and depend, among other factors, on exercise capacity. Purpose: To better understand the pathophysiology of exercise adaptation in native EA. Study Type: Retrospective. Population: Ten patients with unoperated EA (age range 18–61 years) and 13 healthy subjects as controls. Field Strength/Sequence: Balanced steady‐state free precession cine and phase contrast flow sequences at 1.5 T. Assessment: We measured volumes and flows at rest and during submaximal exercise. Hemodynamic parameters including stroke volume (SV), cardiac index (CI), ejection fraction (EF), and tricuspid regurgitation (TR) were calculated. Statistical Tests: We used nonparametric Mann–Whitney U‐test and Wilcoxon signed‐rank test. A P‐value of <0.05 was considered statistically significant. Results: Rest CI and SV were significantly higher in controls; rest heart rate (HR) was similar in the two groups (median 71 bpm by patients and 65 bpm by controls, P = 0.448). During exercise, CI increased significantly in both groups: from 2.40 to 3.35 L/min/m2 in the patient group and from 3.60 to 4.20 L/min/m2 in controls; HR increased significantly in both groups. SV increased significantly in the patient group, whereas it remained stable in controls (P = 0.5284). Patients' median TR decreased significantly: median 42% at rest and 30% during exercise; concomitantly, left ventricular (LV) preload increased significantly (+3% indexed LV end‐diastolic volume) as did LVEF (median 59% at rest vs. 65% during exercise). Data Conclusion: During submaximal exercise, patients with mild to moderate EA improved their cardiovascular system's total efficiency by increasing CI; this was obtained by an increase in HR and by the recruitment of volume, as shown by an increased LV end‐diastolic volume and SV, with simultaneous decrease in TR. This was different from healthy subjects in which CI increased only due to HR increase. Level of Evidence: 3 Technical Efficacy Stage: 3 [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long‐term follow‐up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left‐sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions. [ABSTRACT FROM AUTHOR]

Background: Management of acute decompensated heart failure (ADHF) requires accurate assessment of relative intravascular volume, which may be technically challenging. Inferior vena cava (IVC) collapsibility with respiration reflects intravascular volume and right atrial pressure (RAP). Subclavian vein (SCV) collapsibility may provide an alternative. Hypothesis: The purpose of this study was to examine the relationship between SCV collapsibility index (CI) and IVC CI in ADHF. Methods: This was a prospective study of non‐ventilated patients with ADHF who had paired IVC and SCV ultrasound assessments. As SCV CI is highly position‐dependent, measurements were performed supine at 30–45°. Results: Thirty‐three patients were included with 36 encounters. The sample size was adequately powered for receiver‐operator characteristic (ROC) analysis. SCV CI correlated with IVC CI during relaxed breathing (R =.65, n = 36, p <.001) and forced inhalation (R =.47, n = 36, p =.0036). SCV CI < 22% and >33% corresponded to IVC CI < 20% and >50% suggesting hypervolemia (sensitivity/specificity: 72%) and hypovolemia (sensitivity/specificity: 78%), respectively. Moderate to severe tricuspid regurgitation (TR) compared to less than moderate TR was associated with lower SCV CI (medians: 12.4% vs. 25.3%, p =.022) and IVC CI (medians: 9.6% vs. 35.6%, p =.0012). SCV CI and IVC CI were not significantly different among chronic kidney disease stages. Conclusion: In non‐ventilated ADHF, SCV CI at 30–45° correlates with paired IVC CI, and may provide an alternative to IVC CI for assessment of relative intravascular volume, which may facilitate clinical management. Moderate to severe TR decreases SCV CI and IVC CI and may result in overestimation of relative intravascular volume. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to investigate the prognostic importance of right ventricular dysfunction (RVD) and tricuspid regurgitation (TR) in patients with moderate–severe functional mitral regurgitation (FMR) receiving MitraClip procedure. RVD and TR grade are associated with cardiovascular mortality in the general population and other cardiovascular diseases. However, there are limited data from observational studies on the prognostic significance of RVD and TR in FMR receiving MitraClip procedure. Methods and results: A systemic review and meta‐analysis were performed using MEDLINE, Scopus, and Embase to assess the prognostic value of RVD and TR grade for mortality in patients with functional mitral regurgitation (FMR) receiving MitraClip procedure. Hazard ratios were extracted from multivariate models reporting on the association of RVD and TR with mortality and described as pooled estimates with 95% confidence intervals. A total of eight non‐randomized studies met the inclusion criteria with seven studies having at least 12 months follow‐up with a mean follow‐up of 20.9 months. Among the aforementioned studies, a total of 1112 patients (71.5% being male) were eligible for being included in our meta‐analysis with an overall mortality rate of 28.4% (n = 316). Of the enrolled patients, RVD was present in 46.1% and moderate–severe TR in 29.2%. RVD was significantly associated with mortality compared to normal RV function (HR, 1.79, 95% CI, 1.39–2.31, P < 0.001, I2 = 0). Patients with moderate–severe TR showed increased risk of mortality compared with those in the none‐mild TR group (HR, 1.61. 95% CI, 1.11–2.33, P = 0.01, I2 = 14). Conclusions: This meta‐analysis demonstrates the prognostic importance of RVD and TR grade in predicting all‐cause mortality in patients with significant FMR. RV function and TR parameters may therefore be useful in the risk stratification of patients with significant FMR undergoing MitraClip procedure. [ABSTRACT FROM AUTHOR]

Background: Right-sided heart failure (HF) due to severe tricuspid regurgitation (TR) is associated with reduced quality of life (QoL). Here, we analyzed the impact of TR on specific QoL dimensions and the effect of transcatheter tricuspid valve intervention (TTVI) on individual QoL items., Methods and Results: In this study, we included 174 patients with HF (49% women; median age, 79 years; 97% New York Heart Association ≥3) with baseline QoL assessment undergoing TTVI by transcatheter edge-to-edge-repair at our center between April 2016 and March 2022. QoL was assessed by the standardized Minnesota Living With HF Questionnaire. QoL change after TTVI and correlation to functional end points were analyzed. In addition, all QoL domains and the 21 individual items of the Minnesota Living With HF Questionnaire were analyzed. TTVI significantly reduced TR (TR ≥3: baseline 95%, 1-year-follow-up 7%; P <0.001). Total Minnesota Living with HF Questionnaire score improved from 37 (interquartile range, 26-50) points to 31 (interquartile range, 17-42) points (median follow-up-interval, 355 days; P <0.001). QoL improvement was associated with positive New York Heart Association class, 6-minute walking distance, and actigraphy changes (all P <0.05). The detailed analysis revealed that all items of the physical-related QoL dimension were impaired at baseline and strongly improved after TTVI. In contrast, the emotional and "social" Minnesota Living With HF Questionnaire dimensions were largely unaffected at baseline, yet specific items improved with TTVI., Conclusions: In this single-center study, we delineate the QoL-associated disease burden of TR and identify specific QoL items that improved after TTVI. Our findings support TTVI in patients with reduced QoL and may add to the development of specific tools assessing the functional status of an increasing patient population undergoing TTVI.

A 58‐year‐old male patient was admitted with chest pain and was diagnosed with coronary heart disease. He was scheduled for coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Intraoperative real‐time transesophageal echocardiography (TEE) showed that the tricuspid valves were well‐aligned and subtle regurgitation. Real‐time TEE after separation from CPB showed severe tricuspid regurgitation and prolapsed chordae tendineae. The tricuspid chordae tendineae rupture due to a right atrial venous return cannula. The use of negative pressure to improve venous drainage during CPB may result in the tricuspid valve being adsorbed to the cannula, increasing the likelihood of injury to the tricuspid valve. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether there is evidence for distinct cardiac output (CO) based phenotypes in patients with chronic right heart failure associated with severe tricuspid regurgitation (TR) and to characterize their impact on TR treatment and outcome.Methods and Results: A total of 132 patients underwent isolated transcatheter tricuspid valve repair (TTVR) for functional TR at two centres. Patients were clustered according to k-means clustering into low [cardiac index (CI) < 1.7 L/min/m2 ], intermediate (CI 1.7-2.6 L/min/m2 ) and high CO (CI > 2.6 L/min/m2 ) clusters. All-cause mortality and clinical characteristics during follow-up were compared among different CO clusters. Mortality rates were highest for patients in a low (24%) and high CO state (42%, log-rank P < 0.001). High CO state patients were characterized by larger inferior vena cava diameters (P = 0.003), reduced liver function, higher incidence of ascites (P = 0.006) and markedly reduced systemic vascular resistance (P < 0.001) as compared to TTVR patients in other CO states. Despite comparable procedural success rates, the extent of changes in right atrial pressures (P = 0.01) and right ventricular dimensions (P < 0.001) per decrease in regurgitant volume following TTVR was less pronounced in high CO state patients as compared to other CO states. Successful TTVR was associated with the smallest prognostic benefit among low and high CO state patients.Conclusions: Patients with chronic right heart failure and severe TR display distinct CO states. The high CO state is characterized by advanced congestive hepatopathy, a substantial decrease in peripheral vascular tone, a lack of response of central venous pressures to TR reduction, and worse prognosis. These data are relevant to the pathophysiological understanding and management of this important clinical syndrome. [ABSTRACT FROM AUTHOR]

Background: The pathophysiological mechanisms linking tricuspid regurgitation (TR) and chronic kidney disease (CKD) remain unknown. This study aimed to determine which pathophysiological mechanisms related to TR are independently associated with renal dysfunction and to evaluate the impact of renal impairment on long‐term prognosis in patients with significant (≥ moderate) secondary TR. Methods: A total of 1234 individuals (72 [IQR 63–78] years, 50% male) with significant secondary TR were followed up for the occurrence of all‐cause mortality and the presence of significant renal impairment (eGFR of <60 mL min−1 1.73 m−2) at the time of baseline echocardiography. Results: Multivariable analysis demonstrated that severe right ventricular (RV) dysfunction (TAPSE < 14 mm) was independently associated with the presence of significant renal impairment (OR 1.49, 95% CI 1.11 to 1.99, P = 0.008). Worse renal function was associated with a significant reduction in survival at 1 and 5 years (85% vs. 87% vs. 68% vs. 58% at 1 year, and 72% vs. 64% vs. 39% vs. 19% at 5 years, for stage 1, 2, 3 and 4–5 CKD groups, respectively, P < 0.001). The presence of severe RV dysfunction was associated with reduced overall survival in stage 1–3 CKD groups, but not in stage 4–5 CKD groups. Conclusions: Of the pathophysiological mechanisms identified by echocardiography that are associated with significant secondary TR, only severe RV dysfunction was independently associated with the presence of significant renal impairment. In addition, worse renal function according to CKD group was associated with a significant reduction in survival. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) can occur due to many etiologies, including primary valve disease, left heart disease, annular dilatation in atrial fibrillation, or pulmonary hypertension (PH). Functional TR is caused by tricuspid annular dilatation in the setting of right ventricular remodeling. The right ventricle (RV) ischemia is an overlooked cause of functional TR which tends to diminish with an improvement in right heart functions. We present the case of a patient in whom functional TR significantly improved after percutaneous revascularization. We highlight that the ischemic RV can present with reversible functional TR or PH and emphasized the necessity of accurate detection of the etiology. [ABSTRACT FROM AUTHOR]

Myocardial injury following blunt chest trauma may be difficult to detect. We advocate for cardiac screening in such scenarios. Observation versus intervention should be based on symptoms and the degree of intracardiac disease. [ABSTRACT FROM AUTHOR]