Cardiology, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany.
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2020-001529.
Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.
In this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.
At baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).
While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.
功能性三尖瓣反流（TR）在超声心动图中较为常见。文献表明，严重 TR 与预后不良有关。但目前数据仍有限。本研究旨在评估 TR 患者的长期预后意义。
在这项观察性队列研究中，分析了 1650 例连续患者的数据。主要终点是全因死亡率。平均随访时间为 1090 天。比较了基线和随访时的 TR 分级。进行生存分析以确定预后因素。
基线时，14.1%的患者无 TR，63.8%为轻度 TR，17.4%为中度 TR，4.7%为重度 TR。研究期间 359 例（21.8%）患者死亡。基线时的 TR 与超额死亡率相关。中度和重度 TR 无论收缩期肺动脉压（sPAP）（</≥40mmHg）和左心室射血分数（LV-EF）（</≥50%）如何，在所有亚组中均具有预后意义。在 1 年和 3 年时，中度和重度 TR 伴有 sPAP 升高或 LV-EF 降低的患者的生存最差（p<0.001；p<0.001）。在包括心脏和非心脏危险因素、中度和重度 TR、sPAP 和右心室（RV）功能障碍的多变量模型中，中度和重度 TR、sPAP 和受损的 RV 功能是生存的独立预测因素（HR 1.89，CI 1.07 至 3.36，p=0.029；HR 2.93，CI 1.57 至 5.49，p=0.001；HR 1.44，CI 1.25 至 1.65，p<0.001；HR 1.43，CI 1.14 至 1.79，p=0.002）。随访期间 TR 总体进展率为 28.4%。TR 进展的患者生存明显更差（HR 1.44，CI 1.11 至 1.81；p=0.006）。
尽管 TR 随时间进展，但与长期生存不良相关。TR 分级、RV 功能障碍、sPAP 和 TR 进展是生存的独立预测因素。
