Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Interventions, 16(18), 2245–2258. https://doi.org/10.1016/j.jcin.2023.07.040 Dr. Karl-Philipp Rommel et al.
Points
- Tricuspid transcatheter edge-to-edge repair (TEER) is a potential tricuspid regurgitation (TR) treatment, but patients still face significant risks after the intervention.
- Stressed blood volume (SBV), which generates intravascular pressure, plays a crucial role in hemodynamic derangements in heart failure and may be a target for adjunctive treatment.
- A study investigated the association between estimated stressed blood volume (eSBV) and clinical factors in patients with severe TR undergoing TEER.
- Higher eSBV was associated with obesity, renal and hepatic dysfunction, and cardiac remodeling.
- Patients with higher eSBV demonstrated less reduction in right atrial pressures, peripheral edema, and ascites after TEER. They had a higher risk of death and heart failure hospitalization during follow-up.
Summary
Tricuspid transcatheter edge-to-edge repair (TEER) has been suggested as a potential treatment for patients with tricuspid regurgitation (TR). However, despite the intervention, patients still face significant residual risks. Stressed blood volume (SBV), which generates intravascular pressure, has been identified as a critical factor in hemodynamic derangements in heart failure. This study aimed to investigate the role of SBV in patients with severe TR and its implications for tricuspid TEER.
This study aimed to examine the association between estimated stressed blood volume (eSBV) and various clinical factors, as well as the impact of eSBV on outcomes following tricuspid TEER.
A total of 279 patients with severe TR underwent right heart catheterization before TEER. SBV was estimated using a comprehensive cardiovascular model. The association between eSBV and clinical factors, including obesity, renal and hepatic dysfunction, and cardiac remodeling, was assessed. Hemodynamic correlations were also examined between eSBV and pulmonary artery and cardiac filling pressures and right ventricular-pulmonary artery coupling. The impact of eSBV on post-TEER outcomes, such as reduction in right atrial pressures, peripheral edema, ascites, and occurrence of death and heart failure hospitalization during follow-up, was evaluated.
The study found that eSBV was significantly associated with obesity, renal and hepatic dysfunction, and cardiac remodeling. Hemodynamically, eSBV correlated with pulmonary artery and cardiac filling pressures and right ventricular-pulmonary artery coupling. After TEER, patients with higher eSBV demonstrated less reduction in right atrial pressures, peripheral edema, and ascites than those with lower eSBV. Furthermore, higher eSBV was an independent predictor of the occurrence of death and heart failure hospitalization during the follow-up period.
In patients with severe TR, estimated stressed blood volume (eSBV) is associated with obesity, renal and liver dysfunction, more severe heart failure, attenuated reduction of venous congestion after TEER, and adverse clinical outcomes. These findings highlight the importance of considering SBV in managing tricuspid regurgitation and suggest that estimating SBV could help identify patients who may benefit from additional therapies alongside TEER. SBV estimation in future trials may improve patient selection and optimize treatment outcomes in tricuspid regurgitation management.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S1936879823011986
References Rommel, K.-P., Besler, C., Unterhuber, M., Kresoja, K.-P., Noack, T., Kister, T., Brener, M. I., Fudim, M., Abdel-Wahab, M., Leon, M. B., Thiele, H., Burkhoff, D., & Lurz, P. (2023). Stressed blood volume in severe tricuspid regurgitation: Implications for transcatheter treatment. JACC: Cardiovascular Interventions, 16(18), 2245–2258. https://doi.org/10.1016/j.jcin.2023.07.040
