Takahashi Yusuke, Izumi Chisato, Miyake Makoto, Imanaka Miyako, Kuroda Maiko, Nishimura Shunsuke, Yoshikawa Yusuke, Amano Masashi, Imamura Sari, Onishi Naoaki, Tamaki Yodo, Enomoto Soichiro, Tamura Toshihiro, Kondo Hirokazu, Kaitani Kazuaki, Nakagawa Yoshihisa
Department of Cardiology, Tenri Hospital, Tenri-City, Nara, Japan.
Department of Cardiology, Tenri Hospital, Tenri-City, Nara, Japan.
Int J Cardiol. 2017 Sep 15;243:251-257. doi: 10.1016/j.ijcard.2017.05.031. Epub 2017 May 11.
Patients with atrial fibrillation (AF) without structural heart diseases can show severe tricuspid regurgitation (TR), especially among aged people. The aim of this study was to clarify the actual management, prognosis, and prognostic factors for severe isolated TR associated with AF without structural heart diseases.
We retrospectively investigated actual management in 178 consecutive patients with severe isolated TR associated with AF between 1999 and 2011 in our institution. Prognosis and its predictors were also investigated in 115 patients (68 persistent TR and 47 transient TR) who were followed-up for >1year. During the follow-up period (mean: 5.9years), event free rate from death due to right-sided heart failure (RHF) was 97% at 5years. Persistent TR was associated with higher risk of hospitalization due to RHF than transient TR (log-rank P=0.048) and death due to RHF were all seen in patients with persistent TR who experienced hospitalization due to RHF. Among patients with persistent TR, right ventricular outflow tract dimension >35.3mm, right atrial area >40.3cm, and tenting height >2.1mm were associated with higher risk of hospitalization due to RHF (adjusted hazard ratio: 3.32, 3.83, and 2.89, respectively; P=0.003, 0.002, and 0.009, respectively).
The prognosis of severe isolated TR associated with AF was good with a focus on cardiac death. However, the incidence of cardiac death increased among patients who experienced hospitalization due to RHF. Larger right ventricular outflow tract dimension, right atrial area and tenting height were predictors of hospitalization due to RHF.
无结构性心脏病的心房颤动（AF）患者可出现严重的三尖瓣反流（TR），尤其是在老年人中。本研究的目的是阐明与无结构性心脏病的AF相关的严重孤立性TR的实际管理、预后及预后因素。
我们回顾性研究了1999年至2011年期间在我院连续收治的178例与AF相关的严重孤立性TR患者的实际管理情况。还对115例随访时间超过1年的患者（68例持续性TR和47例短暂性TR）的预后及其预测因素进行了研究。在随访期间（平均5.9年），5年时因右心衰竭（RHF）导致的无死亡事件发生率为97%。持续性TR患者因RHF住院的风险高于短暂性TR患者（对数秩检验P=0.048），且因RHF死亡的患者均为因RHF住院的持续性TR患者。在持续性TR患者中，右心室流出道直径>35.3mm、右心房面积>40.3cm²和瓣叶脱垂高度>2.1mm与因RHF住院的风险较高相关（校正风险比分别为3.32、3.83和2.89；P值分别为0.003、0.002和0.009）。
与AF相关的严重孤立性TR的预后良好，重点关注心源性死亡。然而，因RHF住院的患者中心源性死亡的发生率增加。较大的右心室流出道直径、右心房面积和瓣叶脱垂高度是因RHF住院的预测因素。
