Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel.
Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel.
JACC Cardiovasc Imaging. 2020 Aug;13(8):1643-1651. doi: 10.1016/j.jcmg.2020.01.015. Epub 2020 Apr 15.
The objective of this study was to determine risk factors for progression to hemodynamically significant tricuspid regurgitation (TR) and the population burden attributable to these risk factors.
Few data are available with regard to risk factors associated with the development of hemodynamically significant functional TR.
A total of 1,552 subjects were studied beginning with an index echocardiogram demonstrating trivial or mild TR. Risk factors for progression to moderate or severe TR were determined by using logistic regression and classification trees. Population attributable fractions were calculated for each risk factor.
During a median follow-up time of 38 (interquartile range [IQR]: 26 to 63) months, 292 patients (18.8%) developed moderate/severe TR. Independent predictors of TR progression were age, female sex, heart failure, pacemaker electrode, atrial fibrillation (AF), and indicators of left heart disease, including left atrial (LA) enlargement, elevated pulmonary artery pressure (PAP), and left-sided valvular disease. Classification and regression tree analysis demonstrated that the strongest predictors of TR progression were PAP of ≥36 mm Hg, LA enlargement, age ≥60 years, and AF. In the absence of these 4 risk factors, progression to moderate or severe TR occurred in ∼3% of patients. Age (28.4%) and PAP (20.5%) carried the highest population-attributable fractions for TR progression. In patients with TR progression, there was a marked concomitant increase of incident cases of elevated PAP (40%); mitral and aortic valve intervention (12%); reductions in left ventricular ejection fraction (19%), and new AF (32%) (all p < 0.01).
TR progression is determined mainly by markers of increased left-sided filling pressures (PAP and LA enlargement), AF, and age. At the population level, age and PAP are the most important contributors to the burden of significant TR. TR progression entails a marked parallel increase in the severity of left-sided heart disease.
本研究旨在确定导致中重度三尖瓣反流（TR）进展的危险因素，以及这些危险因素导致的人群负担。
关于导致中重度功能性 TR 进展的危险因素，相关数据较为有限。
共纳入 1552 例患者，所有患者的起始超声心动图均显示为轻度或微量 TR。采用逻辑回归和分类树确定进展为中重度 TR 的危险因素，并计算各危险因素的人群归因分数。
中位随访时间为 38（四分位间距：26 至 63）个月时，292 例患者（18.8%）进展为中重度 TR。TR 进展的独立预测因素包括年龄、女性、心力衰竭、起搏器电极、心房颤动（AF）以及左心疾病的指标，包括左心房（LA）增大、肺动脉压（PAP）升高和左侧瓣膜性疾病。分类和回归树分析显示，TR 进展的最强预测因素是 PAP≥36mmHg、LA 增大、年龄≥60 岁和 AF。如果不存在这 4 个危险因素，中重度 TR 进展发生在约 3%的患者中。年龄（28.4%）和 PAP（20.5%）对 TR 进展的人群归因分数最高。在 TR 进展的患者中，新发 PAP 升高（40%）、二尖瓣和主动脉瓣干预（12%）、左心室射血分数降低（19%）和新发 AF（32%）的发生率均显著增加（均 P<0.01）。
TR 进展主要由左心充盈压（PAP 和 LA 增大）、AF 和年龄的标志物决定。在人群层面，年龄和 PAP 是导致重度 TR 负担的最重要因素。TR 进展与左心疾病严重程度的显著平行增加相关。
