Abstract 18920: Tricuspid Valve Dysfunction in the Setting of Left Heart Valve Disease Begins with Annular Shape Distortion Prior to Dilatation
Introduction: Tricuspid Valve (TV) integrity is a potent predictor of poor prognosis in left heart valve dysfunction (LVD) and is independent of TR severity. Early stages of TV dysfunction prior to regurgitation are important since percutaneous therapies may soon permit early TV intervention. We examined the Tricuspid annulus major/minor axes, annulus area, and right atrial (RA) major/minor axes to detect the earliest stages of TV compromise.
Methods: We analyzed 220 patients by echocardiography and CT angiography. TR was classified into 2 groups, None/Mild (Group 1, n=193) and Moderate/Severe (Group 2, n=27). Group I was subdivided into those without LVD (Group IA, n=140) and those with LVD (Group IB, n=53). GroupIIwas similarly divided (GroupIIA, n=14 no LVD) and (GroupIIB, n=13, LVD). Major and minor tricuspid annulus diameters (TAD) and normalized BSA areas (nTAA) were measured.
Results: Four results occurred in cross-group analyses. 1) Patients without TR had significantly longer minor axes when LVD was present, though TA major axes did not differ (Groups IA vs IB), indicating LVD is associated with TA circularization. 2) Major and minor axes were significantly larger when TR developed regardless of LVD (Groups IA/IB vs IIA/IIB), p<0.05. 3) The RA long axis may determine TR onset in the setting of LVD. 4) TA circularization by minor axis increase was responsible for significantly larger nTAA, with an optimal dilation threshold >928mm2/m2.
Conclusions: This study suggests that 1. LVD plays a role in early TA deformation, rendering it more circular through minor axis increase alone. 2. RA long axis lengthening correlates with TAA and may cause minor axis lengthening. 3. If TR has developed, the TA major and minor axes, and nTAA are enlarged regardless of whether LVD is present. Early changes in the TA minor/major axes and RA long axis may play key roles in prognostication for patients with or without LVD.
- © 2012 by American Heart Association, Inc.