三尖瓣反流速度阈值在肺动脉高压风险评估中的重要性——接受主动脉瓣置换术患者的长期预后
Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement.
作者信息
Garcia-Ribas Cora, Ble Mirea, Gómez Miquel, Mas-Stachurska Aleksandra, Farré-López Núria, Cladellas Mercè
机构信息
Department of Cardiology, Hospital del Mar, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
出版信息
Front Cardiovasc Med. 2021 Nov 10;8:720643. doi: 10.3389/fcvm.2021.720643. eCollection 2021.
The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s). Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm and right ventricle/left ventricle ratio>1 as additional echocardiographic variables. In patients with measurable TRV ( = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, = 0.07) for guidelines threshold. A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.
肺动脉高压(PH)指南提出的三尖瓣反流速度(TRV)2.8米/秒的生理上限受到了质疑。本研究的目的是使用两种不同的TRV阈值(2.55和2.8米/秒)评估主动脉瓣狭窄患者瓣膜置换术后长期PH的预后意义。纳入了444例患者(平均年龄73±9岁;55%为男性),中位随访时间为5.8年(98%完成随访)。根据指南(低、中、高)将患者分为三个PH概率组,两种阈值(TRV≤2.8米/秒和TRV≤2.55米/秒)均采用右心房面积>18平方厘米和右心室/左心室比率>1作为额外的超声心动图变量。在可测量TRV的患者(n = 304)中,对于2.55和2.8米/秒的TRV阈值,低概率组的死亡率分别为25%和30%。TRV>2.55米/秒的中概率组是独立的死亡风险因素(HR 2.04;95%CI:1.91至3.48,P = 0.01),而TRV>2.8米/秒的中概率组则不然(HR 1.44;95%CI:0.89至2.32,P = 0.14)。与各自的低概率组相比,两个高概率组的死亡风险均增加。当纳入所有患者(可测量和不可测量TRV)时,两个中概率组仍与死亡风险增加独立相关:新切点的HR为1.62(95%CI 1.11至2.35,P = 0.01);指南阈值的HR为1.43(95%CI:0.96至2.13,P = 0.07)。2.55米/秒的TRV阈值与右心腔测量值一起,能够更好地评估重度主动脉瓣狭窄继发PH患者(无论有无三尖瓣反流)。