Rodríguez-Palomares José F, Lozano-Torres Jordi, Dentamaro Ilaria, Valente Filipa X, Avilés Augusto Sao, García-Moreno Laura Gutiérrez, Sabaté Pau Rello, Otaegui Imanol, Rosique Beatriz Mínguez, Calabria Hug Cuéllar, Masip Artur Evangelista, Mas Pilar Tornos, Ferreira-González Ignacio, González-Alujas María Teresa
Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Rev Esp Cardiol (Engl Ed). 2021 Aug;74(8):655-663. doi: 10.1016/j.rec.2020.09.008. Epub 2020 Oct 21.
Severe tricuspid regurgitation (TR) is a prevalent valve disease with a high mortality rate. Current guidelines do not define specific thresholds at which patients should be considered for surgery or percutaneous procedures. Thus, patients are usually referred for intervention at a late stage of the disease. This study aimed to assess predictors of cardiovascular outcomes in a prospective cohort of patients with severe TR referred for surgery.
This was an observational, prospective, nonrandomized study. All patients underwent surgery for severe TR based on current clinical guidelines. Complete anamnesis, blood test, echocardiogram, cardiovascular magnetic resonance and right and left catheterization were performed. Patients were followed up in the outpatient department and a combined endpoint (hospitalization for heart failure and cardiovascular mortality) was registered.
Forty-three consecutive patients were included (age: 66.9 ± 9.6 years, 67.4% female). Tricuspid annuloplasty was performed in all patients. After a median follow-up of 38 months, 12 patients (27.9%) showed the combined endpoint and 7 (16.3%) died. Above all clinical, blood and imaging data, the indexed right ventricular end-diastolic volume constituted the best predictor of the combined endpoint (HR, 1.1; P = .02) and cardiovascular mortality (HR, 1.1; P = .05). Furthermore, indexed right ventricular end-diastolic volume was associated with TR recurrence after surgery, with no impact on clinical outcomes.
In patients with severe TR referred for surgery, right ventricular remodeling assessed by cardiovascular magnetic resonance constituted the best independent predictor of cardiovascular outcomes at follow-up.
重度三尖瓣反流（TR）是一种常见的瓣膜疾病，死亡率很高。目前的指南未明确界定患者应考虑接受手术或经皮手术的具体阈值。因此，患者通常在疾病晚期才被转诊接受干预。本研究旨在评估接受手术的重度TR患者队列中心血管结局的预测因素。
这是一项观察性、前瞻性、非随机研究。所有患者均根据当前临床指南接受重度TR手术。进行了完整的病史采集、血液检查、超声心动图、心血管磁共振以及左右心导管检查。在门诊对患者进行随访，并记录复合终点（因心力衰竭住院和心血管死亡）。
连续纳入43例患者（年龄：66.9±9.6岁，女性占67.4%）。所有患者均进行了三尖瓣环成形术。中位随访38个月后，12例患者（27.9%）出现复合终点，7例（16.3%）死亡。在所有临床、血液和影像学数据中，右心室舒张末期容积指数是复合终点（HR，1.1；P = 0.02）和心血管死亡（HR，1.1；P = 0.05）的最佳预测因素。此外，右心室舒张末期容积指数与术后TR复发相关，但对临床结局无影响。
在接受手术的重度TR患者中，通过心血管磁共振评估的右心室重塑是随访期间心血管结局的最佳独立预测因素。
