Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Int J Cardiovasc Imaging. 2020 Jul;36(7):1261-1269. doi: 10.1007/s10554-020-01824-6. Epub 2020 Mar 31.
Functional tricuspid regurgitation (FTR) is associated with prognosis for various heart diseases, but its association with pulmonary hypertension (PH) remains unclear. We studied 111 PH patients. Mid-term follow-up echocardiography was performed 7.1 ± 4.1 months after PH-specific therapy. The severity of FTR was graded as none or trace, mild, moderate, or severe, while more than moderate TR was defined as significant. Moreover, mid-term improvement in FTR after therapy was defined as an improvement in severity of FTR by a grade of 1 or more. Long-term follow-up to determine the primary endpoint of death or hospitalization for heart failure lasted 39 ± 14 months. Mid-term improvement in FTR after PH-specific treatment was observed in 25 patients (23%), and the primary end points occurred in 27 patients (24%) during the long-term follow-up. The Kaplan-Meier curve indicated that the non-FTR group showed more favorable long-term outcomes than the FTR group (log-rank P = 0.008). It further indicated that patients with mid-term improvement in FTR also had more favorable long-term outcomes than those without such improvement (log-rank P = 0.03). When divided into four sub-groups based on combined assessment of baseline FTR and mid-term improvement in FTR, long-term outcomes for patients without mid-term improvement in their baseline FTR were worse than for the other sub-groups (log-rank P = 0.02). Multiple regression analysis showed that a relative change in tricuspid annular diameter at the mid-term follow-up after PH-specific therapy was the only independent determinant parameters for mid-term improvement in FTR. FTR appears to be a valuable factor for predicting long-term outcomes for PH patients, and combined assessment of baseline FTR and mid-term improvement in FTR after PH-specific therapy may have clinical implications for better management of such patients.
功能性三尖瓣反流（FTR）与各种心脏病的预后相关，但与肺动脉高压（PH）的关系尚不清楚。我们研究了 111 例 PH 患者。在 PH 特异性治疗后 7.1±4.1 个月进行中期随访超声心动图检查。FTR 的严重程度分为无或微量、轻度、中度或重度，而重度以上 TR 定义为显著。此外，将治疗后 FTR 中期改善定义为 FTR 严重程度改善 1 级或更高。中期随访以确定死亡或因心力衰竭住院的主要终点持续 39±14 个月。在 25 例患者（23%）中观察到 PH 特异性治疗后 FTR 中期改善，在长期随访中 27 例患者（24%）出现主要终点。Kaplan-Meier 曲线表明非 FTR 组的长期预后优于 FTR 组（对数秩 P=0.008）。进一步表明 FTR 中期改善的患者的长期预后也优于无此类改善的患者（对数秩 P=0.03）。根据基线 FTR 和 FTR 中期改善的联合评估，将患者分为四个亚组，无 FTR 中期改善的患者的长期预后比其他亚组差（对数秩 P=0.02）。多元回归分析显示，PH 特异性治疗后中期随访时三尖瓣环直径的相对变化是 FTR 中期改善的唯一独立决定因素。FTR 似乎是预测 PH 患者长期预后的有价值因素，PH 特异性治疗后基线 FTR 和 FTR 中期改善的联合评估可能对更好地管理此类患者具有临床意义。
