急性心力衰竭患者的功能性三尖瓣反流和再入院。
Functional tricuspid regurgitation and recurrent admissions in patients with acute heart failure.
机构信息
Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain.
CIBER Cardiovascular, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
出版信息
Int J Cardiol. 2019 Sep 15;291:83-88. doi: 10.1016/j.ijcard.2019.03.051. Epub 2019 Mar 27.
BACKGROUND
Functional tricuspid regurgitation (TR) is a common echocardiographic finding in patients with heart failure (HF), and its role in disease progression and prognosis stratification is becoming increasingly relevant in recent years. However, data regarding its association with the burden of HF-readmission is scarce. In this work, we sought to evaluate the association between TR severity and HF-related readmissions following a hospitalization for acute heart failure (AHF).
METHODS
We prospectively included a cohort of 2101 patients admitted with the diagnosis of AHF. TR severity was assessed using a multiparametric integrative approach, and classified as none, mild, moderate, and severe. We used negative binomial regression to identify the association between TR grade and HF-related recurrent admissions. The risk associated to severity of TR was expressed as incidence rate ratio (IRR).
RESULTS
At a median follow-up of 2.53 years (IQR: 1.03-4.36), 978 (46.5%) patients died, and 1657 HF-readmissions occurred in 842 patients (40.0%). The proportion of patients with two or more admissions was 18.4%. The proportion of patients with moderate to severe TR was 17.2%. There was a stepwise increase in the incidence of readmissions from none to severe TR. After multivariable adjustment, only patients with severe TR were independently associated with higher risk of recurrent HF admissions (IRR = 1.34, CI 95%: 1.05-1.71; p = .019).
CONCLUSIONS
In patients with AHF, severe functional TR is independently associated with an increased risk of long-term recurrent HF hospitalizations.
背景
功能性三尖瓣反流（TR）是心力衰竭（HF）患者常见的超声心动图表现，近年来，其在疾病进展和预后分层中的作用变得越来越重要。然而，关于其与 HF 再入院负担的关系的数据却很少。在这项工作中，我们试图评估急性心力衰竭（AHF）住院后 TR 严重程度与 HF 相关再入院之间的关系。
方法
我们前瞻性纳入了 2101 例因 AHF 住院的患者队列。使用多参数综合方法评估 TR 严重程度，并分为无、轻度、中度和重度。我们使用负二项回归来确定 TR 分级与 HF 相关再入院之间的关系。TR 严重程度相关的风险用发病率比（IRR）表示。
结果
中位随访时间为 2.53 年（IQR：1.03-4.36），978 例（46.5%）患者死亡，842 例（40.0%）患者中有 1657 例发生 HF 再入院。两次或以上入院的患者比例为 18.4%。中重度 TR 的患者比例为 17.2%。从无 TR 到重度 TR，再入院的发生率呈逐步增加趋势。多变量调整后，只有重度 TR 患者与 HF 再入院的风险增加独立相关（IRR=1.34，95%CI：1.05-1.71；p=0.019）。
结论
在 AHF 患者中，严重的功能性 TR 与长期 HF 再入院的风险增加独立相关。
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