Kalbacher Daniel, Schäfer Ulrich, von Bardeleben R Stephan, Zuern Christine S, Bekeredjian Raffi, Ouarrak Taoufik, Sievert Horst, Nickenig Georg, Boekstegers Peter, Senges Jochen, Schillinger Wolfgang, Lubos Edith
Universitäres Herzzentrum Hamburg, Hamburg, Germany.
EuroIntervention. 2017 Feb 3;12(15):e1809-e1816. doi: 10.4244/EIJ-D-16-00850.
We sought to assess the impact of tricuspid regurgitation (TR) severity on patient outcome in a collective with relevant mitral regurgitation undergoing MitraClip implantation..
From August 2010 to July 2013, 766 patients (age 75.3±8.5 years, 61% male, median EuroSCORE 24.3%±18.4) were prospectively enrolled in the TRAMI registry and stratified by echocardiography into no/mild, moderate and severe TR. Overall, the mean number of implanted MitraClips was higher in patients with severe TR but increasing TR severity was not associated with procedural success. In-hospital and one-year mortality as well as MACE and MACCE (death, myocardial infarction±stroke) rates were higher with increasing TR severity. Kaplan-Meier curves indicated a significant difference for mortality (p<0.0001), but not for rehospitalisation for heart failure. After multivariate Cox regression, severe TR proved to be a predictor for one-year mortality (HR 2.01, 95% CI: 1.25-3.26, p=0.004). Higher rates of severe bleeding were more frequent with increasing TR grades.
In patients with MitraClip implantation, increasing TR severity is associated with adverse outcome, higher bleeding rates and decreased survival rates.
我们试图评估三尖瓣反流（TR）严重程度对接受MitraClip植入术且伴有相关二尖瓣反流患者预后的影响。
2010年8月至2013年7月，766例患者（年龄75.3±8.5岁，61%为男性，欧洲心脏手术风险评估系统（EuroSCORE）中位数为24.3%±18.4）前瞻性纳入TRAMI注册研究，并通过超声心动图分为无/轻度、中度和重度TR。总体而言，重度TR患者植入MitraClip的平均数量更高，但TR严重程度增加与手术成功率无关。随着TR严重程度增加，住院和1年死亡率以及主要不良心血管事件（MACE）和主要不良心血管和脑血管事件（MACCE，死亡、心肌梗死±中风）发生率更高。Kaplan-Meier曲线显示死亡率有显著差异（p<0.0001），但因心力衰竭再次住院率无显著差异。多因素Cox回归分析后，重度TR被证明是1年死亡率的预测因素（风险比2.01，95%置信区间：1.25-3.26，p=0.004）。随着TR分级增加，严重出血发生率更高。
在接受MitraClip植入术的患者中，TR严重程度增加与不良预后、更高的出血率和更低的生存率相关。
