Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands; Department of Molecular Medicine, University of Pavia, Pavia, Italy.
Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands.
Am J Cardiol. 2020 Dec 1;136:131-139. doi: 10.1016/j.amjcard.2020.09.022. Epub 2020 Sep 15.
Secondary tricuspid regurgitation (TR) imposes a chronic volume overload on the right ventricle (RV) which can increase RV wall tension (RVWT). The aim of this study was to investigate the prognostic implications of increased RVWT in patients with significant secondary TR. A total of 1,142 patients with moderate-to-severe secondary TR were included. Based on the simplified Laplace-Young's law, RVWT was defined as the product between pulmonary artery systolic pressure (PASP) and RV base-to-apex length. The association between RVWT and risk of all-cause death was identified with spline curve analysis and patients were divided according to the cut-off of RVWT beyond which the hazard ratio (HR) and 95% confidence interval for all-cause mortality were above 1. Four hundred sixty-five (41%) patients had RVWT >3,300 mm Hg x mm and formed the group with increased RVWT. Patients with increased RVWT were more likely male, had more frequent heart failure symptoms and presented with more co-morbidities, larger RV and left ventricular (LV) dimensions, worse LV function, more severe secondary TR and higher PASP compared with patients with nonincreased RVWT. During a median follow-up of 51 (17 to 86) months, 586 (51%) patients died. The cumulative 5-year survival rate was significantly worse in patients with increased RVWT as compared with patients with nonincreased RVWT (38% vs 63% p <0.001). After correcting for potential confounders, increased RVWT retained an independent association with all-cause mortality (HR 1.555; 95% CI 1.268 to 1.907; p <0.001). In conclusion, increased RVWT is independently associated with worse prognosis and its evaluation may improve risk stratification in patients with significant secondary TR.
继发性三尖瓣反流（TR）会给右心室（RV）造成慢性容量超负荷，从而增加 RV 壁张力（RVWT）。本研究旨在探讨在有明显继发性 TR 的患者中 RVWT 增加的预后意义。共纳入 1142 例中重度继发性 TR 患者。根据简化的拉普拉斯-杨定律，RVWT 定义为肺动脉收缩压（PASP）与 RV 基底至心尖长度的乘积。通过样条曲线分析确定 RVWT 与全因死亡风险的关系，并根据 RVWT 的截断值将患者分为 RVWT 增加组和 RVWT 不增加组，RVWT 增加组的危险比（HR）和全因死亡率的 95%置信区间大于 1。465 例（41%）患者的 RVWT >3300mm Hg·mm，形成 RVWT 增加组。与 RVWT 不增加组相比，RVWT 增加组患者更可能为男性，心力衰竭症状更频繁，合并症更多，RV 和左心室（LV）尺寸更大，LV 功能更差，继发性 TR 更严重，PASP 更高。在中位数为 51（17 至 86）个月的随访期间，586 例（51%）患者死亡。与 RVWT 不增加组相比，RVWT 增加组患者的 5 年累积生存率显著更差（38%比 63%，p<0.001）。在校正了潜在混杂因素后，RVWT 增加与全因死亡率仍有独立关联（HR 1.555；95%CI 1.268 至 1.907；p<0.001）。总之，RVWT 增加与预后不良独立相关，其评估可能有助于改善有明显继发性 TR 的患者的风险分层。
