University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Edwards Lifesciences, Nyon, Switzerland.
Can J Cardiol. 2021 Jul;37(7):1078-1085. doi: 10.1016/j.cjca.2020.12.012. Epub 2020 Dec 25.
Growing evidence shows a major outcome impact and undertreatment of tricuspid regurgitation (TR), but large and comprehensive contemporary reports of management and outcome at the nationwide level are lacking.
We gathered all consecutive patients admitted with a diagnosis of likely functional TR in 2014-2015 in France from the Programme de Médicalisation des Systèmes d'Information national database and collected rate of surgery, in-hospital mortality, 1-year mortality, or heart failure (HF) readmission rates.
In 2014-2015, 17,676 consecutive patients (75 ± 14 years of age, 51% female) were admitted with a TR diagnosis. Charlson index was ≥ 2 in 56% of the population and 46% presented with HF. TR was associated with prior cardiac surgery, ischemic/dilated cardiomyopathy, or mitral regurgitation in 73% of patients. Only 10% of TR patients overall and 67% of those undergoing mitral valve surgery received a tricuspid valve intervention. Among the 13,654 (77%) conservatively managed patients, in-hospital mortality, 1-year mortality, and 1-year mortality or HF readmission rates were 5.1%, 17.8%, and 41%, respectively, overall, and 5.3%,17.2%, and 37%, respectively, among those with no underlying medical conditions (8-fold higher than predicted for age and gender).
This nationwide cohort of patients admitted with TR included elderly patients with frequent comorbidities/underlying cardiac diseases. In patients conservatively managed, mortality and morbidity were considerably high over a short time span. Despite this poor prognosis, only 10% of patients underwent a tricuspid valve intervention. These nationwide data showing a considerable risk and potential underuse of treatment highlight the critical need to develop strategies to improve the management and outcomes of TR patients.
越来越多的证据表明三尖瓣反流（TR）对预后有重大影响且治疗不足，但缺乏全国范围内大规模且全面的关于其治疗方法和结果的当代报告。
我们从法国国家信息医疗化计划数据库中收集了 2014 年至 2015 年期间所有因疑似功能性 TR 而入院的连续患者，并收集了手术率、住院死亡率、1 年死亡率或心力衰竭（HF）再入院率。
2014 年至 2015 年，17676 例连续患者（年龄 75±14 岁，51%为女性）被诊断为 TR。56%的患者Charlson 指数≥2，46%的患者有 HF。TR 与既往心脏手术、缺血性/扩张型心肌病或二尖瓣反流相关，占患者的 73%。仅 10%的 TR 患者和 67%接受二尖瓣手术的患者接受了三尖瓣瓣膜干预。在 13654 例（77%）接受保守治疗的患者中，住院死亡率、1 年死亡率和 1 年死亡率或 HF 再入院率分别为 5.1%、17.8%和 41%，在无基础疾病的患者中分别为 5.3%、17.2%和 37%（比年龄和性别预测值高 8 倍）。
该全国性 TR 患者队列包括患有常见合并症/潜在心脏疾病的老年患者。在接受保守治疗的患者中，在短时间内死亡率和发病率相当高。尽管预后不佳，但只有 10%的患者接受了三尖瓣瓣膜干预。这些全国性数据表明存在相当大的风险和潜在治疗不足，突出了制定策略以改善 TR 患者管理和预后的迫切需要。
