Kardiologia polska · 2026
Tricuspid annular diameter as a predictor of persistent significant tricuspid regurgitation following transcatheter atrial septal defect closure: A prospective single center study.
СтатьяНазвание и аннотация: Перевод в очереди
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Sachajko Zuzanna, Tworek Michał, Trojanowicz Katarzyna, Bielecka Klaudia, Pacia Klaudia, Sobień Bartosz, Wilkołek Piotr, Przewłocki Tadeusz, Komar Monika
Аннотация
BACKGROUND: Functional tricuspid regurgitation (TR) is frequently present in adults with secundum atrial septal defect (ASD) due to chronic right-sided volume overload and right heart remodeling.
AIMS: The aim of this study is to evaluate changes in TR severity, tricuspid annular and right ventricular (RV) reverse remodeling 12 months after transcatheter ASD closure, including RV systolic function assessed by conventional parameters and RV free wall longitudinal strain (RVFWLS). We also evaluated baseline echocardiographic predictors of persistent ≥ moderate TR at follow-up.
METHODS: We prospectively enrolled 200 adult patients (150 women, 50 men) with the median age of 35 years (interquartile range 25.0-48.5) undergoing transcatheter closure of secundum ASD. Transthoracic echocardiography was performed before the procedure and at 12-month follow-up to assess TR severity, RV and tricuspid annular dimensions and RV systolic function, including RVFWLS. Persistent TR was defined as ≥ moderate TR at 12 months. Baseline predictors of persistent TR were evaluated using univariate and multivariable logistic regression analyses.
RESULTS: The severity of TR was reduced after 12 months (P <0.001), with a significant increase in the number of patients without TR from 0% to 19% and a decrease in the incidence of severe TR (7% vs. 1%). An improvement in the semi quantitative and quantitative parameters of TR was noted, including the width of the vena contracta (median 3.0 vs. 2.0 mm), the effective regurgitant orifice area (median 0.20 vs. 0.18 cm²), and the regurgitant volume (median 15.0 vs. 12.0 ml) (P <0.001). Reverse remodeling was observed in the form of a decrease in the diameter of the tricuspid valve annulus (median 35.0 vs. 33.0 mm; P <0.001) and the diameter of the proximal part of the RV outflow tract (median 32.0 vs. 28.0 mm; P <0.001). RV systolic function also improved, as evidenced by improvements in echocardiographic parameters: RVFWLS, tricuspid annular plane systolic excursion, s', fractional area change, and Right Ventricular Index of Myocardial Performance (P <0.001). At 12 months, 80 patients (40%) had persistent ≥ moderate TR. In multivariable analysis, baseline tricuspid annular diameter (odds ratio, 4.53; 95% confidence interval [CI], 2.26-9.10; P <0.001) and baseline TR regurgitant volume (odds ratio, 1.28; 95% CI, 1.15-1.43; P <0.001) independently predicted persistent ≥ moderate TR. Receiver operating characteristic analysis demonstrated excellent discrimination for predicting clinically significant TR (area under the curve 0.97; 95% CI, 0.951-0.989), with an optimal annular diameter cut off of 39 mm.
CONCLUSIONS: Transcatheter ASD closure is associated with significant improvement in functional TR and right heart reverse remodeling at 12 months, accompanied by improved RV systolic function. Annular diameter >39 mm identifies patients at increased odds of persistent significant TR after device closure and may support consideration of surgical ASD closure with concomitant tricuspid annuloplasty.
AIMS: The aim of this study is to evaluate changes in TR severity, tricuspid annular and right ventricular (RV) reverse remodeling 12 months after transcatheter ASD closure, including RV systolic function assessed by conventional parameters and RV free wall longitudinal strain (RVFWLS). We also evaluated baseline echocardiographic predictors of persistent ≥ moderate TR at follow-up.
METHODS: We prospectively enrolled 200 adult patients (150 women, 50 men) with the median age of 35 years (interquartile range 25.0-48.5) undergoing transcatheter closure of secundum ASD. Transthoracic echocardiography was performed before the procedure and at 12-month follow-up to assess TR severity, RV and tricuspid annular dimensions and RV systolic function, including RVFWLS. Persistent TR was defined as ≥ moderate TR at 12 months. Baseline predictors of persistent TR were evaluated using univariate and multivariable logistic regression analyses.
RESULTS: The severity of TR was reduced after 12 months (P <0.001), with a significant increase in the number of patients without TR from 0% to 19% and a decrease in the incidence of severe TR (7% vs. 1%). An improvement in the semi quantitative and quantitative parameters of TR was noted, including the width of the vena contracta (median 3.0 vs. 2.0 mm), the effective regurgitant orifice area (median 0.20 vs. 0.18 cm²), and the regurgitant volume (median 15.0 vs. 12.0 ml) (P <0.001). Reverse remodeling was observed in the form of a decrease in the diameter of the tricuspid valve annulus (median 35.0 vs. 33.0 mm; P <0.001) and the diameter of the proximal part of the RV outflow tract (median 32.0 vs. 28.0 mm; P <0.001). RV systolic function also improved, as evidenced by improvements in echocardiographic parameters: RVFWLS, tricuspid annular plane systolic excursion, s', fractional area change, and Right Ventricular Index of Myocardial Performance (P <0.001). At 12 months, 80 patients (40%) had persistent ≥ moderate TR. In multivariable analysis, baseline tricuspid annular diameter (odds ratio, 4.53; 95% confidence interval [CI], 2.26-9.10; P <0.001) and baseline TR regurgitant volume (odds ratio, 1.28; 95% CI, 1.15-1.43; P <0.001) independently predicted persistent ≥ moderate TR. Receiver operating characteristic analysis demonstrated excellent discrimination for predicting clinically significant TR (area under the curve 0.97; 95% CI, 0.951-0.989), with an optimal annular diameter cut off of 39 mm.
CONCLUSIONS: Transcatheter ASD closure is associated with significant improvement in functional TR and right heart reverse remodeling at 12 months, accompanied by improved RV systolic function. Annular diameter >39 mm identifies patients at increased odds of persistent significant TR after device closure and may support consideration of surgical ASD closure with concomitant tricuspid annuloplasty.