Küçük, Hi̇lal Olgun

Background Tricuspid regurgitation (TR) is a common valvular disorder that can affect patients’ quality of life and survival. The impact of TR etiology on overall survival and the associated risk factors in each subgroup are not well studied. Methods Multisite, retrospective study evaluating survival based on TR etiology using Kaplan–Meier and Cox regression models. Stepwise approach was used to define TR etiology (≥moderate): primary (PTR; presence of a primary valvular pathology), lead associated (LTR; lead interfering with closure), and secondary TR (STR) in the setting of left‐sided valvular disease, left ventricular disease, other causes of pulmonary hypertension, right ventricular disease, and atrial secondary TR. Results A total of 12 899 patients were included (3% PTR, 90% STR, 7% LTR). The mean age was 68±14, 73±13, and 71±13 years, respectively (44%–55% female patients). Adjusting for age, sex, and TR severity, patients with PTR had better overall survival (PTR: reference; STR hazard ratio [HR], 1.4 [1.2–1.6], LTR HR, 1.5 [1.1–1.7]). On multivariable Cox regression, the Tricuspid Regurgitation Impact on Outcomes score was associated with mortality across all groups ( P <0.05 for all). In addition, other risk factors associated with worse outcomes included pulmonary hypertension and ≥moderate right ventricular enlargement in PTR; left‐sided valvular disease, pulmonary hypertension, and ≥moderate right ventricular dysfunction in STR; and left ventricular disease and ≥moderate right ventricular dysfunction in LTR. Conclusions Patients with PTR have better survival than STR and LTR. Tricuspid Regurgitation Impact on Outcomes score was associated with mortality across etiologies, whereas other risk factors are etiology specific. Improved risk profiling may enhance patient selection, treatment decisions, and outcomes.

Abstract Background Cardiac masses encompass a broad differential, including benign tumours, malignancies, and pseudotumours. Accurate diagnosis requires integration of clinical context, patient characteristics, lesion location, and imaging features. In select cases, tissue characterization is necessary. We describe a case of a rapidly enlarging interatrial mass following transcatheter aortic valve implantation (TAVI). Case summary A 70-year-old man underwent TAVI for severe low-flow, low-gradient aortic stenosis. Preprocedural imaging revealed an incidental interatrial mass consistent with lipomatous hypertrophy of the atrial septum (LHAS). Six months later, the mass showed significant interval growth, raising concern for malignancy. Multimodality imaging, including cardiac magnetic resonance imaging and FDG positron emission tomography yielded indeterminate results. An echocardiography-guided biopsy was performed, and histopathologic analysis confirmed LHAS with intralesional haemorrhage likely incurred during the TAVI procedure. Discussion While LHAS is typically benign and stable or slowly progressive, rare cases may present with atypical features and rapid growth, mimicking malignant cardiac tumours. This case represents the first reported instance of LHAS with haemorrhagic expansion.

Introduction: Tricuspid regurgitation is a common echocardiographic finding leading to excess morbidity and mortality in adult population. Hypothesis: Racial and ethnic disparities have been observed in various cardiovascular disorders’ prevalence and natural course, including valvular lesions. However, little is known about the epidemiology and clinical correlations of TR among non-Hispanic Black adults. Methods: To examine risk factors and clinical outcomes in non-Hispanic Black adults with moderate or more severe TR, 685 patients (7%) self-identified as non-Hispanic Black and 9127 (93%) self-identified as non-Hispanic White with a first echocardiographic report of moderate or more severe TR between 2005-2016 were studied. Results: Non-Hispanic Black patients had more severe TR when compared to white patients (25% vs. 20%, p<0.001). After adjusting for age and sex, non-Hispanic Black patients had significantly higher 10-year all-cause mortality (HR=1.34 (1.18, 1.52), p<0.001). Black race remained a risk factor for all-cause mortality even after adjustment for comorbidities like CHF, COPD, DM, CKD, hypertension, and ischemic heart disease (HR=1.23 (1.08, 1.40), p=0.002). Conclusions: Significant racial disparities exist in demographic, clinical and echocardiographic characteristics between non-Hispanic Black and White patients with moderate or more severe TR. Black race is a potential disease modifier leading to excess mortality.

Abstract Aims Beat-to-beat variability in cycle length is well-known in atrial fibrillation (Afib); whether this also translates to variability in annulus size remains unknown. Defining annulus maximal size in Afib is critical for accurate selection of percutaneous devices given the frequent association with mitral and tricuspid valve diseases. Methods and results Images were obtained from 170 patients undergoing 3D echocardiography [100 (50 sinus rhythm (SR) and 50 Afib) for mitral annulus (MA) and 70 (35 SR and 35 Afib) for tricuspid annulus (TA)]. Images were analysed for differences in annular dynamics with a commercially available software. Number of cardiac cycles analysed was 567 in mitral valve and 346 in tricuspid valve. Median absolute difference in maximal MA area over four to six cycles was 1.8 cm2 (range 0.5–5.2 cm2) in Afib vs. 0.8 cm2 (range 0.1–2.9 cm2) in SR, P &lt; 0.001. Maximal MA area was observed within 30–70% of the R-R interval in 81% of cardiac cycles in SR and in 73% of cycles in Afib. Median absolute difference in maximal TA area over four to six cycles was 1.4 cm2 (range 0.5–3.6 cm2) in Afib vs. 0.7 cm2 (range 0.3–1.7 cm2) in SR, P &lt; 0.001. Maximal TA area was observed within 60–100% of the R-R interval in 81% of cardiac cycles in SR, but only in 49% of cycles in Afib. Conclusion MA and TA reach maximal size within a broad time interval centred around end-systole and end-diastole, respectively, with significant beat-to-beat variability. Afib leads to a larger beat-to-beat variability in both timing of occurrence and values of annulus size than in SR.

Lung ultrasound (LUS) detects the presence of extravascular lung water (EVLW) through the visualization of B-Line artifacts. However, the qualitative nature of LUS limits its effectiveness in serial or longitudinal studies such as evaluating changes in EVLW at different time points in patients undergoing diuretic therapy for congestive heart failure. Lung ultrasound surface wave elastography (LUSWE) is a novel technique using a small handheld device that can measure superficial lung tissue elastic properties. We aimed to evaluate the use of LUSWE to measure quantitative changes in lung elasticity caused by acute changes in EVLW. We performed LUSWE on consecutive days in 14 patients hospitalized for acute congestive heart failure with evidence of pulmonary edema (clinical EVLW). From day#1 to day#2, the patients had an average diuresis of net negative 2.1 l associated with an average decrease in 13 B-Lines by lung ultrasound, signifying a reduction in EVLW. LUSWE analysis demonstrated a significant reduction (p &lt; 0.05) in surface wave velocity in all interrogated intercostal spaces from day#1 to day#2. In summary, LUSWE performed at the bedside was able to demonstrate improvement in lung compliance (decreased elasticity) correlating with a reduction in EVLW in hospitalized patients being treated for congestive heart failure.