Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany.
Can J Cardiol. 2021 Jul;37(7):1086-1093. doi: 10.1016/j.cjca.2021.01.006. Epub 2021 Jan 13.
Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR.
Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed.
Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001).
Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.
功能性三尖瓣反流（TR）在超声心动图中较为常见。尽管普遍认为右心室（RV）功能障碍会影响 TR 患者的预后，但仍不清楚哪些超声心动图参数能最准确地反映预后。本研究旨在评估 TR 患者 RV 功能障碍的发生率及其预后价值。
对 1089 例连续患者的数据进行分析。三尖瓣环平面收缩期位移（TAPSE）、面积变化分数和右心室游离壁纵向应变（RV 应变）用于定义 RV 功能障碍。患者随访 2 年全因死亡率。为了预测生存，使用 TR 分级作为参考模型，对 RV 功能参数的重新分类和 C 统计进行了评估。
在研究的患者中，13.9%无 TR，61.2%为轻度 TR，19.6%为中度 TR，5.3%为重度 TR。TR 分级与死亡率增加相关（对数秩检验，P<0.001）。RV 应变和 TAPSE 受损是死亡率的独立预测因素（RV：危险比[HR]，1.130；95%置信区间[CI]，1.099-1.160；P<0.001；TAPSE：HR，1.131；95%CI，1.085-1.175；P<0.001）。RV 应变和 TAPSE 均提高了生存预测的参考模型（RV：综合鉴别改善[IDI]，0.184；95%CI，0.146-0.221；P<0.001；TAPSE：IDI，0.057；95%CI，0.037-0.077；P<0.001）。
超声心动图评估 RV 功能似乎对 TR 患者有用。RV 应变评估对预测 2 年死亡率具有额外价值。
