Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan.
Heart Vessels. 2022 May;37(5):755-764. doi: 10.1007/s00380-021-01973-1. Epub 2021 Oct 22.
Tricuspid regurgitation (TR) is a common condition that is independently associated with high mortality rates in patients with heart failure (HF). Several studies have demonstrated the clinical efficacy of add-on tolvaptan in patients hospitalized for HF. However, the effects of add-on tolvaptan in patients with significant TR are less well understood. Among the patients with moderate-to-severe TR assessed by transthoracic echocardiography during hospitalization for congestive HF, 39 patients who could complete the clinical course after starting add-on tolvaptan were included in the study. Rehospitalization due to HF and cardiac death were defined as adverse cardiac events in this study. We investigated the presence or absence of cardiac events within 2 years following the introduction of tolvaptan and evaluated echocardiographic functional parameters associated with cardiac events. The average patient age was 75 ± 14 years, and 23 patients (59%) experienced adverse cardiac events within 2 years after add-on tolvaptan administration. Serum creatinine (mg/dL) and brain natriuretic peptide (pg/mL) concentrations at discharge were significantly higher in patients with cardiac events than in those without cardiac events {1.48 [1.02-1.58] vs. 1.07 [0.79-1.41], p = 0.03; 526 [414-1044] vs. 185 [104-476], p = 0.01, respectively}. The presence or absence of past hospitalization for HF was also significantly higher in the event-positive group compared to event-free group (78 vs. 44%, p = 0.04). Comparison of echocardiographic parameters revealed that patients with cardiac events had a significantly lower left ventricular ejection fraction (40 ± 16 vs. 49 ± 15%, p = 0.049) and lower right ventricular fractional area change (RVFAC) (35 ± 12 vs. 45 ± 10%, p = 0.008) than those without cardiac events. Multiple logistic regression analysis revealed that RVFAC and past hospitalization for HF were independently associated with cardiac events following the introduction of tolvaptan (odds ratio, 0.934 and 4.992; p = 0.048 and 0.04, respectively). Right ventricular contractility as well as past history of admission for HF, left ventricular ejection fraction, renal function, and brain natriuretic peptide level at discharge may reflect the clinical outcomes after HF hospitalization in patients with significant TR who were treated with tolvaptan.
三尖瓣反流（TR）是心力衰竭（HF）患者死亡率高的一个常见病症。多项研究表明，HF 住院患者加用托伐普坦具有临床疗效。然而，加用托伐普坦对中重度 TR 患者的效果还不太清楚。在因充血性 HF 住院期间接受经胸超声心动图评估的中重度 TR 患者中，有 39 例患者在开始加用托伐普坦后能够完成临床治疗过程，将其纳入本研究。本研究中，因 HF 再次住院和心脏死亡被定义为不良心脏事件。我们调查了加用托伐普坦后 2 年内是否存在心脏事件，并评估了与心脏事件相关的超声心动图功能参数。患者平均年龄为 75±14 岁，23 例（59%）在加用托伐普坦后 2 年内发生不良心脏事件。与无心脏事件患者相比，发生心脏事件患者的出院时血肌酐（mg/dL）和脑利钠肽（pg/mL）浓度显著更高{1.48[1.02-1.58] vs. 1.07[0.79-1.41]，p=0.03；526[414-1044] vs. 185[104-476]，p=0.01}。心脏事件阳性组的既往 HF 住院率也显著高于无心脏事件组（78% vs. 44%，p=0.04）。超声心动图参数比较显示，与无心脏事件患者相比，发生心脏事件患者的左心室射血分数显著更低（40±16% vs. 49±15%，p=0.049），右心室射血分数（RVFAC）也显著更低（35±12% vs. 45±10%，p=0.008）。多变量逻辑回归分析显示，RVFAC 和既往 HF 住院史与加用托伐普坦后的心脏事件独立相关（比值比，0.934 和 4.992；p=0.048 和 0.04）。右心室收缩力以及既往 HF 住院史、左心室射血分数、肾功能和脑利钠肽水平可能反映了在加用托伐普坦治疗中重度 TR 患者 HF 住院后的临床结局。
