Patlolla Sri Harsha, Schaff Hartzell V, Nishimura Rick A, Stulak John M, Chamberlain Alanna M, Pislaru Sorin V, Nkomo Vuyisile T
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2022 Dec 13;80(24):2289-2298. doi: 10.1016/j.jacc.2022.09.045.
Atrial fibrillation (AF) is considered a risk factor for isolated tricuspid valve regurgitation (TR) in the absence of other known etiologies.
This study sought to identify the incidence of clinically significant isolated TR and its impact in patients with AF.
A population-based record linkage system was used to identify adult patients with new-onset AF. Patients with evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery, impaired left ventricular systolic/diastolic function at baseline were excluded. The remaining patients (n = 691) were followed over time to identify development of moderate or greater TR and assess its impact on subsequent survival.
A total of 232 patients (33.6%) developed moderate or greater TR. Among these, 73 patients (10.6%) had isolated TR without significant underlying structural heart disease. Incidence rate of any moderate or greater TR was 3.9 cases and that of isolated TR was 1.3 cases per 100 person-years. Permanent/persistent AF and female sex were associated with increased risk of developing TR, whereas rhythm control was associated with lower risk of TR. Over a median clinical follow-up of 13.3 years (IQR: 10.0-15.9 years), development of any moderate or greater TR (HR: 2.92; 95% CI: 2.29-3.73; P < 0.001) and isolated significant TR (HR: 1.51; 95% CI: 1.03-2.22; P = 0.03) were associated with an adjusted increased risk of subsequent mortality.
In this population-based cohort of patients with AF, nearly one-third developed moderate or greater TR over time. Incident significant TR and incident isolated significant TR portend a worse survival in patients with AF.
在无其他已知病因的情况下，心房颤动（AF）被认为是孤立性三尖瓣反流（TR）的一个危险因素。
本研究旨在确定具有临床意义的孤立性TR的发生率及其对AF患者的影响。
使用基于人群的记录链接系统来识别新发AF的成年患者。排除有中度或更严重三尖瓣疾病、左侧瓣膜疾病、肺动脉高压、既往心脏手术、基线时左心室收缩/舒张功能受损证据的患者。对其余患者（n = 691）进行随访，以确定中度或更严重TR的发生情况，并评估其对后续生存的影响。
共有232例患者（33.6%）发生了中度或更严重的TR。其中，73例患者（10.6%）有孤立性TR，无明显潜在结构性心脏病。任何中度或更严重TR的发生率为每100人年3.9例，孤立性TR的发生率为每100人年1.3例。永久性/持续性AF和女性与发生TR的风险增加相关，而节律控制与TR风险降低相关。在中位临床随访13.3年（四分位间距：10.0 - 15.9年）期间，任何中度或更严重TR（风险比：2.92；95%置信区间：2.29 - 3.73；P < 0.001）和孤立性严重TR（风险比：1.51；95%置信区间：1.03 - 2.22；P = 0.03）与调整后后续死亡风险增加相关。
在这个基于人群的AF患者队列中，近三分之一的患者随着时间的推移发生了中度或更严重的TR。新发严重TR和新发孤立性严重TR预示着AF患者的生存情况更差。
