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Ventricular Interaction in a Patient With Heart Failure With Preserved Ejection Fraction and Severe Tricuspid Regurgitation

2021; Lippincott Williams & Wilkins; Volume: 14; Issue: 10 Linguagem: Inglês

10.1161/circheartfailure.121.008768

1941-3297

Karl‐Patrik Kresoja, Karl‐Philipp Rommel, Hölger Thiele, Philipp Lurz,

Cardiac Structural Anomalies and Repair

HomeCirculation: Heart FailureVol. 14, No. 10Ventricular Interaction in a Patient With Heart Failure With Preserved Ejection Fraction and Severe Tricuspid Regurgitation Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessResearch ArticlePDF/EPUBVentricular Interaction in a Patient With Heart Failure With Preserved Ejection Fraction and Severe Tricuspid Regurgitation Karl-Patrik Kresoja, MD, Karl-Philipp Rommel, MD, Holger Thiele, MD and Philipp Lurz, MD, PhD Karl-Patrik KresojaKarl-Patrik Kresoja Correspondence to: Karl-Patrik Kresoja, MD, Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany. Email E-mail Address: [email protected] https://orcid.org/0000-0002-8616-6751 Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). Leipzig Heart Institute at Heart Center Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). , Karl-Philipp RommelKarl-Philipp Rommel https://orcid.org/0000-0002-2901-8138 Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). Leipzig Heart Institute at Heart Center Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). , Holger ThieleHolger Thiele https://orcid.org/0000-0002-0169-998X Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). Leipzig Heart Institute at Heart Center Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). and Philipp LurzPhilipp Lurz https://orcid.org/0000-0002-5993-4487 Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). Leipzig Heart Institute at Heart Center Leipzig, Germany (K.-P.K., K.-P.R., H.T., P.L.). Originally published30 Sep 2021https://doi.org/10.1161/CIRCHEARTFAILURE.121.008768Circulation: Heart Failure. 2021;14:e008768An 80-year-old female presented for evaluation of transcatheter tricuspid valve repair (TTVR) for symptomatic severe functional tricuspid regurgitation. Echocardiography (effective regurgitant office area 0.5 cm2) and right heart catheterization (right atrial pressure waveform ventricularization) confirmed the diagnosis. Furthermore, the diagnosis of heart failure with preserved ejection fraction was established (left ventricular [LV] ejection fraction 64% and mean pulmonary capillary wedge pressure 26 mm Hg). Cardiac magnetic resonance imaging confirmed preserved LV ejection fraction but showed impaired right ventricular (RV) function (46%) and dilatation (RV end-diastolic volume index 122 mL/m2). Septal bowing was observed both in echocardiography as well as cardiac magnetic resonance imaging. The patient was deemed at prohibitive surgical risk and referred to TTVR using the PASCAL system (Edwards Lifesciences, Irvine, CA). During the procedure, a conductance catheter was placed in the LV to investigate changes in LV filling by recording pressure-volume loops. After deployment of 2 PASCAL devices, TTVR was successful, and tricuspid regurgitation was reduced to grade I. Right atrial pressure was reduced. LV end-diastolic volume increased from 91 to 114 mL, whereas LV end-diastolic pressure remained comparable (Figure). The LV end-diastolic pressure-volume relationship was estimated as described before1,2 and showed a rightward shift suggesting improved LV filling.Download figureDownload PowerPointFigure. Pressure-volume loops of the left ventricle (LV) before and after transcatheter tricuspid valve repair (TTVR). *Values were acquired before the TTVR procedure within routine right heart catheterization.TTVR has been described to have favorable effects in heart failure with preserved ejection fraction.3 Using state-of-the-art hemodynamic assessment, we identified increased LV end-diastolic volume at maintained LV end-diastolic pressure as a possible mechanism for this favorable effect. TTVR has been described to improve LV filling,4 but LV end-diastolic pressure is expected to increase alongside LV end-diastolic volume. More physiological RV/LV interaction might be responsible for amended LV filling. Given the limited pericardial space,5 a decrease in the volume overloaded RV after TTVR might allow for improved LV distension and explain stable filling pressures at improved preload. In some patients with severe RV failure or severe precapillary pulmonary hypertension TTVR might lead to dangerous acute increases in afterload and cause acute RV failure.Sources of FundingNone.Disclosures Dr Lurz has been a consultant to Abbott Structural Heart, Edwards Lifesciences, and Medtronic. The other authors report no conflicts.FootnotesCorrespondence to: Karl-Patrik Kresoja, MD, Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany. Email karl-patrik.[email protected]uni-leipzig.deReferences1. Ten Brinke EA, Burkhoff D, Klautz RJ, Tschöpe C, Schalij MJ, Bax JJ, van der Wall EE, Dion RA, Steendijk P. Single-beat estimation of the left ventricular end-diastolic pressure-volume relationship in patients with heart failure.Heart. 2010; 96:213–219. doi: 10.1136/hrt.2009.176248CrossrefMedlineGoogle Scholar2. Kresoja KP, Rommel KP, Fengler K, von Roeder M, Besler C, Lücke C, Gutberlet M, Desch S, Thiele H, Böhm M, et al.. Renal sympathetic denervation in patients with heart failure with preserved ejection fraction.Circ Heart Fail. 2021; 14:e007421. doi: 10.1161/CIRCHEARTFAILURE.120.007421LinkGoogle Scholar3. Kresoja KP, Lauten A, Orban M, Rommel KP, Alushi B, Besler C, Braun D, Unterhuber M, Stangl K, Landmesser U, et al.. Transcatheter tricuspid valve repair in the setting of heart failure with preserved or reduced left ventricular ejection fraction.Eur J Heart Fail. 2020; 22:1817–1825. doi: 10.1002/ejhf.1975CrossrefMedlineGoogle Scholar4. Rommel KP, Besler C, Noack T, Blazek S, von Roeder M, Fengler K, Ender J, Gutberlet M, Desch S, Borger MA, et al.. Physiological and clinical consequences of right ventricular volume overload reduction after transcatheter treatment for tricuspid regurgitation.JACC Cardiovasc Interv. 2019; 12:1423–1434. doi: 10.1016/j.jcin.2019.02.042CrossrefMedlineGoogle Scholar5. Borlaug BA, Reddy YNV. The role of the pericardium in heart failure: implications for pathophysiology and treatment.JACC Heart Fail. 2019; 7:574–585. doi: 10.1016/j.jchf.2019.03.021CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 2021Vol 14, Issue 10Article InformationMetrics Download: 152 © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.121.008768PMID: 34665675 Originally publishedSeptember 30, 2021 Keywordsechocardiographycathetertricuspid valveheart failuremagnetic resonance imagingPDF download SubjectsTreatmentValvular Heart DiseaseHeart Failure