Department of Medicine, Columbia University, New York, NY
Department of Medicine, Columbia University, New York, NY.
J Am Heart Assoc. 2018 Jun 24;7(13):e008813. doi: 10.1161/JAHA.118.008813.
Although implantation of a left ventricular assist device (LVAD) generally improves tricuspid regurgitation (TR) in short-term follow-up, the clinical significance of residual TR in patients with mid- to long-term LVAD support is unknown. This study aimed to identify the prevalence, predictors, and prognostic value of residual TR in LVAD patients in association with tricuspid valve (TV) deformation.
The study cohort consisted of 127 patients who underwent LVAD implantation without TV procedure and were supported with LVAD at least 1 year. All patients underwent echocardiographic examination preoperatively and 1 year after LVAD implantation. TR was quantitatively assessed by ratio of TR color jet area/right atrial area, and significant residual TR was defined as ≥20% of %TR at follow-up echocardiographic examination. Detailed echocardiographic measurements were also performed, including TV annulus diameter, TV leaflet displacement, and left ventricular and right ventricular systolic function. LVAD implantation significantly improved ratio of TR color jet area/right atrial area as well as left ventricular and right ventricular systolic function and tethering distance (all <0.05), whereas it enlarged TV annulus diameter (=0.002). Significant residual TR was observed in 30 (23.6%) patients. Age, preoperative TV annulus diameter, and residual mitral regurgitation were significantly associated with significant residual TR (all <0.05), whereas TV tethering was not. During a mean follow-up of 21±17 months, patients with residual TR had significantly higher mortality than those without residual TR (log-rank <0.001).
Significant residual TR was observed in ≈25% patients supported with LVAD over 1 year and was associated with unfavorable outcome.
尽管左心室辅助装置（LVAD）的植入通常会改善短期随访中的三尖瓣反流（TR），但在接受 LVAD 中至长期支持的患者中，残余 TR 的临床意义尚不清楚。本研究旨在确定与三尖瓣（TV）变形相关的 LVAD 患者中残余 TR 的患病率、预测因素和预后价值。
研究队列包括 127 名接受 LVAD 植入术且未行 TV 手术的患者，这些患者在接受 LVAD 支持至少 1 年后接受了超声心动图检查。所有患者均在术前和 LVAD 植入后 1 年接受了超声心动图检查。TR 通过 TR 彩色射流面积/右心房面积的比值进行定量评估，将随访超声心动图检查中≥20%的%TR 定义为显著残余 TR。还进行了详细的超声心动图测量，包括 TV 瓣环直径、TV 瓣叶位移以及左心室和右心室收缩功能。LVAD 植入术显著改善了 TR 彩色射流面积/右心房面积以及左心室和右心室收缩功能和牵拉力（均<0.05），而 TV 瓣环直径则增大（=0.002）。30 名（23.6%）患者存在显著残余 TR。年龄、术前 TV 瓣环直径和残余二尖瓣反流与显著残余 TR 显著相关（均<0.05），而 TV 牵拉力则无显著相关性。在平均 21±17 个月的随访期间，有残余 TR 的患者的死亡率明显高于无残余 TR 的患者（对数秩检验<0.001）。
在接受 LVAD 支持 1 年以上的患者中，约 25%存在显著残余 TR，且与不良预后相关。
