Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):993-1001. doi: 10.1093/ehjci/jex343.
Significant tricuspid regurgitation (TR) is common in heart failure (HF) and portends poor prognosis. We sought to determine whether the poor outcome results from the TR itself, or whether the TR is a surrogate marker of advanced left-sided myocardial or valvular heart disease.
We studied 639 patients admitted for acute HF. The relationship between TR severity and the endpoint of readmission for HF or mortality was assessed after adjustment for multiple clinical and echocardiographic parameters. Higher TR grade was associated with higher congestion score and with other cardiac abnormalities including reduced left ventricular systolic function, moderate or severe mitral regurgitation, pulmonary hypertension (PH, defined as pulmonary artery systolic pressure ≥ 50 mmHg), and right ventricular dysfunction (all P < 0.001). Only 7% of patients with moderate or severe TR were free of other cardiac lesions. In adjusted models, moderate or severe TR was not associated with readmission for HF or mortality [hazard ratio (HR) 1.24, 95% confidence interval (95% CI) 0.97-1.57]. Patients with moderate/severe TR had similar risk for HF readmission or death compared with patients with trivial/mild TR when PH was not present (HR 1.17; 95% CI 0.78-1.75, P = 0.40) whereas the risk was higher in moderate/severe TR and PH (HR 1.78; 95% CI 1.34-2.36, P < 0.0001).
Patients presenting with symptomatic HF and significant TR have multiple coexisting cardiac abnormalities. TR provides no additive risk in the presence of normal or mildly elevated pulmonary pressures. However, it is associated with excess rehospitalizations and mortality in patients with PH.
三尖瓣重度反流（TR）在心力衰竭（HF）中很常见，并预示着预后不良。我们试图确定不良预后是源于 TR 本身，还是 TR 是左心心肌或瓣膜性心脏病进展的替代标志物。
我们研究了 639 例因急性 HF 入院的患者。在调整了多个临床和超声心动图参数后，评估了 TR 严重程度与 HF 再入院或死亡率终点之间的关系。较高的 TR 分级与更高的充血评分以及其他心脏异常相关，包括左心室收缩功能降低、中度或重度二尖瓣反流、肺动脉高压（定义为肺动脉收缩压≥50mmHg）和右心室功能障碍（所有 P<0.001）。只有 7%的中度或重度 TR 患者没有其他心脏病变。在调整后的模型中，中度或重度 TR 与 HF 再入院或死亡无关[风险比（HR）1.24，95%置信区间（95%CI）0.97-1.57]。当不存在 PH 时，中度/重度 TR 患者的 HF 再入院或死亡风险与轻度 TR 患者相似（HR 1.17；95%CI 0.78-1.75，P=0.40），而中度/重度 TR 和 PH 患者的风险更高（HR 1.78；95%CI 1.34-2.36，P<0.0001）。
患有症状性 HF 和严重 TR 的患者有多种并存的心脏异常。在正常或轻度升高的肺压存在的情况下，TR 不会增加风险。然而，在 PH 患者中，TR 与再住院和死亡率增加相关。
