New in Clinical Guidance | Evaluation, Management of Tricuspid Regurgitation; Role of Inflammation in CVD
Evaluation, Management of Tricuspid Regurgitation Focus of New ECDP
The ACC has released a new Expert Consensus Decision Pathway (ECDP) addressing "10 issues for the clinician in tricuspid regurgitation (TR) evaluation and management." The ECDP focuses specifically on patients with secondary TR in the chronic setting and is intended to serve as a bridge to a future update of ACC/AHA valvular heart disease guidelines.
"The availability of transcatheter interventions to treat severe TR has energized the cardiovascular community to improve evaluation and management strategies targeted at this valve lesion," write Patrick T. O'Gara, MD, MACC, Writing Committee chair, JoAnn Lindenfeld, MD, FACC, Writing Committee vice chair, et al. "This ECDP is intended to enable the clinician to assimilate the most important developments in this dynamically evolving field to improve the care of patients with severe TR ... and is focused on the most common clinical areas encountered in practice from evaluation to treatment."
The ECDP provides a pathway for TR evaluation and management based on five steps: identify, define, assess, treat and follow-up. An informed shared decision-making process involving a multidisciplinary team is incorporated throughout. Pathway highlights include recommendations for early screening for TR, along with use of transthoracic echocardiography as the preferred imaging modality for defining the etiology, mechanism and severity of TR. Transesophageal echocardiography, cardiac CT and cardiac MR, along with selective use of cardiac catheterization, can be used to augment characterization of TR severity.
Use of guideline-directed medical therapy and intervention is recommended where indicated to manage left-sided heart disease. The Writing Committee also suggests that patients with moderate or greater TR, especially those with progressing heart failure symptoms and/or escalated diuretic therapy, should be considered for referral to an advanced heart disease specialist.
In addition, "an informed shared decision-making process, incorporating individual patient values and preferences, as well as consensus multidisciplinary team recommendations, are essential for patient management," write the Committee members.
ACC Scientific Statement Details Role of Inflammation in CVD
An ACC Scientific Statement on Inflammation and Cardiovascular Disease highlights new groundbreaking research linking inflammation and atherosclerotic cardiovascular disease (ASCVD) and provides consensus-based recommendations for evaluation, treatment and prevention reflecting this new era.
"The evidence linking inflammation with ASCVD is no longer exploratory but is compelling and clinically actionable," write the authors, led by Writing Committee Chair George A. Mensah, MD, FACC. "The time for taking action has now arrived."
The Statement includes specific recommendations for screening, evaluation and CVD risk assessment; inflammatory biomarkers in cardiovascular imaging; inflammation inhibition in behavioral and lifestyle risks; and anti-inflammatory approaches in primary and secondary prevention as well as in heart failure and other cardiovascular diseases.
Among the key takeaways:
- High-sensitivity C-reactive protein (hsCRP) is an inexpensive and widely available blood test. While there has been debate within the medical community regarding the utility of hsCRP, this statement details the data confirming its value in clinical decision-making in primary and secondary prevention.
- In patients with known CVD, hsCRP level is at least as predictive of future events as LDL-C levels, even in patients treated with statin therapy.
- The important role of lifestyle interventions to reduce systemic inflammation is emphasized, including regular exercise (≥150 minutes/week), Mediterranean or DASH Diet, and intake of omega-3 fatty acids, including two to three meals per week of fatty fish high in EPA and DHA. This advice aligns with lifestyle management recommendations in the 2025 ACC/AHA High Blood Pressure Guideline.
The Statement also discusses current challenges and opportunities based on the new evidence, exploring topics like the advancing field of cardio-immunology and areas for further research, such as the interplay between inflammation and key physiological systems, the role of novel special pro-resolving bioactive lipid molecules in promoting the resolution of inflammation and CVD risk reduction, and more.
The authors close with a call for action to "embrace anti-inflammatory interventions in patients with established ASCVD" and for clinical practice guidelines that implement "broad screening of primary and secondary prevention patients for hsCRP, in combination with LDL cholesterol." Additionally, they note: "The time is also ripe for the development of strategies to promote increased physician awareness of the crucial role of inflammation in CVD and accelerate the adoption of evidence-based, guideline-directed anti-inflammatory therapy through dissemination and implementation research."
Read the full statement published in JACC.
Clinical Topics: Dyslipidemia, Noninvasive Imaging, Valvular Heart Disease, Vascular Medicine, Lipid Metabolism, Nonstatins, Echocardiography/Ultrasound
Keywords: Cardiology Magazine, ACC Publications, Cholesterol, LDL, Cardiovascular Diseases, Inflammation, Carotid Artery Diseases, Cardiac Catheterization, Echocardiography, Decision Making, Aortic Valve Disease, Tricuspid Valve Insufficiency, Regurgitation
