Cho Jae Yeong, Kim Kye Hun, Kim Jong Yoon, Sim Doo Sun, Yoon Hyun Ju, Yoon Nam Sik, Hong Young Joon, Park Hyung Wook, Kim Ju Han, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun
Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
J Cardiol. 2016 Nov;68(5):419-425. doi: 10.1016/j.jjcc.2015.11.010. Epub 2016 Mar 15.
Atrial remodeling associated with atrial fibrillation (AF) is known to be a risk factor for significant tricuspid regurgitation (TR), but the predictor of reversible TR in patients with severe functional TR and AF has been poorly studied. The aim of this study was to investigate the predictors of reversible TR in patients with severe functional TR and AF.
Among 232 patients with severe TR, a total of 71 patients with severe functional TR and AF were enrolled and divided into 2 groups: reversible TR group (n=16, 70.1±15.5 years, 7 males) vs. non-reversible TR group (n=55, 72.3±11.8 years, 20 males). Improvement of TR to moderate or lesser degree on follow-up (FU) echocardiography was considered as reversible TR in the present study.
During 38.9±26.7 months of FU period, reversible TR was observed in 16 patients (22.5%). The presence of left ventricular (LV) systolic dysfunction was significantly prevalent (43.8% vs. 20.0%, p=0.03) and the improvement in LV ejection fraction (EF) more than 10% on FU echocardiography was more significantly frequent (62.5% vs. 23.3%, p=0.003) in the reversible TR group than in the non-reversible TR group. However, the other echocardiographic parameters, including right ventricular function were not different between the groups. In multivariate analysis using Cox proportional hazard model, the improvement of LVEF more than 10% was the only independent predictor of reversible TR (HR=7.39, 95%CI 1.80-30.28, p=0.005). Nine patients died only in patients with non-reversible TR (12.7%), but the reversibility of TR was not associated with mortality.
The improvement of LV systolic function was the only independent predictor of reversible TR. Appropriate medical therapy including management for heart failure should be considered before performing surgery in patients with severe functional TR and AF, especially in patients with LV dysfunction.
与心房颤动（AF）相关的心房重构是严重三尖瓣反流（TR）的一个危险因素，但对于严重功能性TR和AF患者中可逆性TR的预测因素研究较少。本研究的目的是调查严重功能性TR和AF患者中可逆性TR的预测因素。
在232例严重TR患者中，共纳入71例严重功能性TR和AF患者，并分为2组：可逆性TR组（n = 16，年龄70.1±15.5岁，男性7例）与不可逆性TR组（n = 55，年龄72.3±11.8岁，男性20例）。在本研究中，随访（FU）超声心动图显示TR改善至中度或更低程度被视为可逆性TR。
在38.9±26.7个月的FU期内，16例患者（22.5%）观察到可逆性TR。可逆性TR组左心室（LV）收缩功能障碍的发生率显著更高（43.8%对20.0%，p = 0.03），且FU超声心动图显示LV射血分数（EF）提高超过10%的情况在可逆性TR组比不可逆性TR组更频繁（62.5%对23.3%，p = 0.003）。然而，包括右心室功能在内的其他超声心动图参数在两组之间并无差异。在使用Cox比例风险模型的多变量分析中，LVEF提高超过10%是可逆性TR的唯一独立预测因素（HR = 7.39，95%CI 1.80 - 30.28，p = 0.005）。仅9例患者死亡，均在不可逆性TR组（12.7%），但TR的可逆性与死亡率无关。
LV收缩功能的改善是可逆性TR的唯一独立预测因素。对于严重功能性TR和AF患者，尤其是LV功能障碍患者，在进行手术前应考虑包括心力衰竭管理在内的适当药物治疗。
