Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium.
Am J Cardiol. 2020 Nov 15;135:84-90. doi: 10.1016/j.amjcard.2020.08.034. Epub 2020 Aug 28.
The prognostic impact of isolated tricuspid regurgitation (TR) in patients with atrial fibrillation (AF) has not been investigated. The purpose of this study was to investigate the prognostic implications of significant isolated TR in AF patients without left-sided heart disease, pulmonary hypertension, or primary structural abnormalities of the tricuspid valve. A total of 63 AF patients with moderate and severe TR were matched for age and gender to 116 AF patients without significant TR. Patients were followed for the occurrence of all-cause mortality, hospitalization for heart failure and stroke. Patients with significant isolated TR (mean age 71 ± 8 years, 57% men) more often had paroxysmal AF as compared with patients without TR (mean age 71 ± 7 years, 60% men) (60% vs 43%, p = 0.028). In addition, right atrial size and tricuspid annular diameter were significantly larger in patients with significant isolated TR compared with their counterparts. During follow-up (median 62 [34 to 95] months), 53 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with significant isolated TR were 76% and 56%, compared with 92% and 85% for patients without significant TR, respectively (Log rank Chi-Square p <0.001). The presence of significant isolated TR was independently associated with the combined endpoint (hazard ratio, 2.853; 95% confidence interval, 1.458 to 5.584; p = 0.002). In conclusion, in the absence of left-sided heart disease and pulmonary hypertension, significant isolated TR is independently associated with worse event-free survival in patients with AF.
孤立性三尖瓣反流（TR）对心房颤动（AF）患者的预后影响尚未得到研究。本研究旨在探讨无左心疾病、肺动脉高压或三尖瓣原发性结构异常的 AF 患者中严重孤立性 TR 的预后意义。共纳入 63 例中重度 TR 的 AF 患者，并按年龄和性别与 116 例无明显 TR 的 AF 患者进行配对。随访患者全因死亡率、心力衰竭和中风住院情况。与无 TR 患者相比，有明显孤立性 TR 的患者（平均年龄 71±8 岁，57%为男性）更常发生阵发性 AF（平均年龄 71±7 岁，60%为男性）（60%比 43%，p=0.028）。此外，与无 TR 的患者相比，有明显孤立性 TR 的患者右心房大小和三尖瓣环直径明显更大。在随访期间（中位数 62[3495]个月），共有 53 例患者发生复合终点事件。有明显孤立性 TR 的患者 1 年和 5 年无事件生存率分别为 76%和 56%，而无明显 TR 的患者分别为 92%和 85%（Log rank Chi-Square p<0.001）。有明显孤立性 TR 与复合终点独立相关（风险比 2.853；95%置信区间 1.4585.584；p=0.002）。总之，在无左心疾病和肺动脉高压的情况下，严重孤立性 TR 与 AF 患者无事件生存率较差独立相关。
