BACKGROUND Transcatheter tricuspid valve-in-valve replacement (TVIV) is an emerging therapy for dysfunctional surgical valves in patients with congenital and acquired TV disease. The present study was performed to establish baseline quantitative data for echocardiographic and invasive parameters obtained pre- and immediately post-TVIV. METHODS Patients were drawn from the VIVID Registry. This study included two cohorts. The registry cohort included all patients entered in the VIVID registry through February 2017 who had both echocardiographic and invasively measured gradients across the TV. The focused cohort comprised a subset of patients from a single institution who had both pre- and post-TVIV echocardiogram images reviewed offline by a single investigator. The echocardiographic variables measured were based on published guidelines from the American Society of Echocardiography. RESULTS Assessment of paired pre- and/or postimplant echocardiographic and invasive pressure measurements (n = 199) showed reasonable correlation between mean TV gradient measured invasively with cardiac catheterization and noninvasively both pre- and post-TVIV (R = 0.72, P < .001), although there was a bias toward the echocardiographic gradient being higher than the invasively measured gradient and sizable discrepancies were reported in several patients. In the focused cohort (n = 42), the mean TV inflow gradient was 9.3 ± 5.0 mm Hg pre- and 5.6 ± 2.3 mm Hg post-TVIV (P < .001). The TV pressure halftime and TV:left ventricular outflow tract Doppler velocity index were 215 ± 94 msec and 3.4 ± 1.2, respectively, at baseline, and 170 ± 44 msec and 2.4 ± 0.6 post-TVIV. Both the Doppler velocity index and the TV E velocity correlated with the mean TV inflow gradient. CONCLUSIONS This study provides benchmark data for the echocardiographic assessment of valve function after TVIV. In this population, the significance of an inflow gradient after TVIV should be interpreted in the clinical context. The appropriate threshold for defining dysfunction may differ from the levels proposed for assessment of native or newly placed surgical valves.

中文翻译：

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超声心动图评估正在接受经导管三尖瓣瓣膜置换术的患者。

背景技术经导管三尖瓣置换术（TVIV）是一种针对先天性和获得性电视疾病患者手术瓣膜功能异常的新兴疗法。进行本研究是为了为在TVIV之前和之后立即获得的超声心动图和侵入性参数建立基线定量数据。方法患者来自VIVID注册中心。这项研究包括两个队列。该登记队列包括截至2017年2月进入VIVID登记系统的所有患者，其在电视上均具有超声心动图和侵入性测量的梯度。重点研究的人群包括来自单个机构的一部分患者，这些患者的TVIV前后的超声心动图图像均由一位研究者进行离线检查。测得的超声心动图变量基于美国超声心动图学会发布的指南。结果对植入前和/或植入后超声心动图和有创压力测量值（n = 199）的评估显示，在用心导管进行有创测量的平均电视斜度与无创TVIV前后的平均TV梯度之间存在合理的相关性（R = 0.72，P <.001 ），尽管对超声心动图梯度的偏倚高于侵入性测量的梯度，并且在几例患者中报告了相当大的差异。在重点人群中（n = 42），TVIV前的平均电视流入梯度为9.3±5.0 mm Hg，TVIV后的平均电视流入梯度为5.6±2.3 mm Hg（P <.001）。TV压力半衰期和TV：左室流出道多普勒速度指数分别为215±94毫秒和3.4±1.2，在基线时，TVIV后为170±44毫秒和2.4±0.6。多普勒速度指数和TV E速度均与平均TV流入梯度相关。结论本研究为TVIV后瓣膜功能的超声心动图评估提供了基准数据。在这一人群中，应在临床背景下解释TVIV后流入梯度的重要性。定义功能障碍的适当阈值可能与为评估天然或新放置的手术瓣膜而建议的水平有所不同。TVIV后流入梯度的重要性应在临床背景下进行解释。定义功能障碍的适当阈值可能不同于为评估天然或新放置的手术瓣膜而建议的水平。TVIV后流入梯度的重要性应在临床背景下进行解释。定义功能障碍的适当阈值可能不同于为评估天然或新放置的手术瓣膜而建议的水平。