Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute (NL-HI), Utrecht, The Netherlands.
Int J Cardiol. 2017 Sep 15;243:191-193. doi: 10.1016/j.ijcard.2017.05.122. Epub 2017 Jun 2.
Little is known on the clinical course of tricuspid regurgitation (TR) in patients with repaired tetralogy of Fallot (rTOF) and which patients are at particular risk. This study aims to determine TR course, characteristics associated with TR progression, and the prognostic relevance of TR in rTOF patients.
In this dualcenter cohort study, rTOF patients from a prospective national registry with ≥1 cardiac magnetic resonance imaging study and ≥2 echocardiograms available were included. Clinical and imaging data were collected. Cox hazards regression analysis was used to assess patient characteristics associated with progression to severe TR and whether severe TR was associated with the combined clinical endpoint of tachyarrhythmia, heart failure, and death, as time-dependent factor.
A total of 216 patients were included (57% men, age 34±12years); 11 patients (5%) had severe TR at baseline. During 7.6±3.5years of follow-up, progression to severe TR occurred in 15 patients (7%). NYHA class ≥2 (HR 5.38, 95%-C.I. 1.91-15.16, p=0.001) and moderate baseline TR (HR 13.10, 95%-C.I. 2.95-58.21, p=0.001) were independently associated with progression to severe TR. Adverse events occurred in 47 patients (22%). The occurrence of severe TR was independently associated with adverse events (HR 3.48, 95%-C.I. 1.68-7.21, p=0.001).
In this study, severe TR was present in 12% of adult rTOF patients during 7.6years, and progression to severe TR was most likely in symptomatic patients with moderate baseline TR. In these patients, close surveillance is warranted, because the occurrence of severe TR was associated with worse prognosis.
关于修复性法洛四联症（rTOF）患者三尖瓣反流（TR）的临床病程以及哪些患者风险特别高，目前知之甚少。本研究旨在确定 rTOF 患者 TR 的病程、与 TR 进展相关的特征以及 TR 在 rTOF 患者中的预后相关性。
在这项双中心队列研究中，纳入了来自国家前瞻性注册研究的至少有 1 次心脏磁共振成像研究和至少 2 次超声心动图检查结果的 rTOF 患者。收集临床和影像学数据。使用 Cox 风险回归分析评估与进展为重度 TR 相关的患者特征，以及重度 TR 是否与心动过速、心力衰竭和死亡的综合临床终点相关，作为时间依赖性因素。
共纳入 216 例患者（57%为男性，年龄 34±12 岁）；11 例（5%）患者在基线时存在重度 TR。在 7.6±3.5 年的随访期间，15 例（7%）患者进展为重度 TR。NYHA 分级≥2（HR 5.38，95%-CI 1.91-15.16，p=0.001）和中度基线 TR（HR 13.10，95%-CI 2.95-58.21，p=0.001）与进展为重度 TR 独立相关。47 例（22%）患者发生不良事件。重度 TR 的发生与不良事件独立相关（HR 3.48，95%-CI 1.68-7.21，p=0.001）。
在这项研究中，7.6 年内，12%的成年 rTOF 患者存在重度 TR，且在有中度基线 TR 的有症状患者中，进展为重度 TR 的可能性最大。在这些患者中，需要密切监测，因为重度 TR 的发生与预后较差相关。
