Offen Sophie, Strange Geoff, Playford David, Celermajer David S, Stewart Simon
Faculty of Medicine and Health, University of Sydney, NSW, Australia; Dept of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Heart Research Institute, Sydney, NSW, Australia; The University of Notre Dame Australia, Fremantle, WA, Australia.
Int J Cardiol. 2023 Jan 1;370:338-344. doi: 10.1016/j.ijcard.2022.10.160. Epub 2022 Oct 29.
We sought to analyse the distribution of TR severity and survival in a large cohort of adults with CIED leads.
The distribution of TR severity was analysed in 18,797 adults (mean age 73.8+/-13.9, 63.3% men) with CIED leads undergoing echocardiography across 25 centres. Survival status and cause of death were linked and the relationship between TR severity and mortality during 2.6 (interquartile range 1.1-4.6) years follow-up examined. Data from 439,558 individuals (mean age 62.1 ±17.8 years, 51.5% men) without a CIED were subsequently incorporated in a pooled cohort analysis.
Overall, 8,824/18,797 individuals (47%) with a CIED had no/trivial TR; 5,490 (29.2%) mild TR; 3,068 (16.3%) moderate TR; and 1,415 (7.5%) severe TR. Moderate or greater TR was independently associated with age, female sex, atrial fibrillation and significant left heart disease (p<0.001 for all). 8,868 individuals (47.2%) died from any cause (43.2% from cardiovascular causes). Individuals with moderate or severe TR had a 1.6 to 2.5-fold increased risk of all-cause mortality in adjusted models, compared to those with no TR (p<0.001 for both). In the pooled cohort analysis, CIEDs were associated with a near 2-fold (95% CI 1.81-1.99; p<0.001) increased probability of moderate or greater TR, on adjusted basis. However, the mortality associated with moderate or greater TR did not differ significantly with respect to the presence or absence of a device lead.
Moderate or greater TR is more prevalent in those with CIED's, even in adjusted models, and was independently associated with incremental risks for all-cause and cardiovascular mortality.
我们试图分析一大群有心脏植入电子设备（CIED）导联的成年人中三尖瓣反流（TR）严重程度的分布及生存率。
在25个中心对18797名有CIED导联且接受超声心动图检查的成年人（平均年龄73.8±13.9岁，男性占63.3%）的TR严重程度分布进行分析。将生存状态和死亡原因相关联，并在2.6年（四分位间距1.1 - 4.6年）的随访期间检查TR严重程度与死亡率之间的关系。随后将来自439558名无CIED的个体（平均年龄62.1±17.8岁，男性占51.5%）的数据纳入汇总队列分析。
总体而言，18797名有CIED的个体中，8824名（47%）无/微量TR；5490名（29.2%）轻度TR；3068名（16.3%）中度TR；1415名（7.5%）重度TR。中度或更严重的TR与年龄、女性性别、心房颤动和显著的左心疾病独立相关（所有p<0.001）。8868名个体（47.2%）死于任何原因（43.2%死于心血管原因）。与无TR的个体相比，中度或重度TR个体在调整模型中的全因死亡率风险增加1.6至2.5倍（两者p<0.001）。在汇总队列分析中，经调整后，CIED与中度或更严重TR的发生概率增加近2倍（95%置信区间1.81 - 1.99；p<0.001）相关。然而，与中度或更严重TR相关的死亡率在有无设备导联方面无显著差异。
即使在调整模型中，中度或更严重的TR在有CIED的个体中更普遍，并且与全因和心血管死亡率的增加风险独立相关。
