Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milano, Italy.
Eur J Heart Fail. 2012 Aug;14(8):902-8. doi: 10.1093/eurjhf/hfs063. Epub 2012 May 2.
The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR.
We enrolled 373 consecutive patients (mean age 68±11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1-120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36±2% and 55±4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-2.1, P = 0.01) was an independent determinant of HF. The incidence of HF was 41±5, 46±7, 57±7, and 65±8% for patients without, and with mild, moderate, and severe FTR respectively (P = 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5±2% and 60±3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2-2.1, P = 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69±2.5, 67±2.1, 51±2.5, and 40±4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P = 0.004).
Moderate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.
三尖瓣反流（TR）与器质性左心瓣膜病相关的预后作用是众所周知的。然而，在功能性二尖瓣反流（FMR）和左心室（LV）功能障碍患者中，功能性 TR（FTR）的预后价值尚缺乏相关数据。本研究旨在评估 FTR 在 FMR 患者心力衰竭（HF）和死亡发生中的预后作用。
我们纳入了 373 例连续的 LV 功能障碍且至少存在轻度 FMR 并伴有或不伴有 FTR 的患者（平均年龄 68±11 岁），均通过超声心动图定量评估。中位随访时间为 32 个月（范围 1-120 个月）；分别有 132 例（35.4%）和 97 例患者发生 HF 或死亡。3 年和 6 年时 HF 的发生率分别为 36±2%和 55±4%。中重度 FTR[风险比（HR）1.4，95%置信区间（CI）1.1-2.1，P=0.01]是 HF 的独立决定因素。无 FTR、轻度、中度和重度 FTR 的患者 HF 发生率分别为 41±5%、46±7%、57±7%和 65±8%（P=0.03）。3 年和 6 年时全因死亡率为 77.5±2%和 60±3%。中重度 FTR（HR 1.6，95%CI 1.2-2.1，P=0.01）是全因死亡率的独立决定因素。6 年时，无 FTR、轻度、中度和重度 FTR 的患者全因死亡率分别为 69±2.5%、67±2.1%、51±2.5%和 40±4.8%（P=0.004）。
在 FMR 患者中，中度或更严重的 FTR 与较差的生存和较高的 HF 发作发生率独立相关。
