重度三尖瓣反流的自然病史及中期预后：一项队列研究。

Natural history and mid-term prognosis of severe tricuspid regurgitation: A cohort study.

作者信息

Samim Daryoush, Praz Fabien, Cochard Baptiste, Brugger Nicolas, Ruberti Andrea, Bartkowiak Joanna, Corpataux Noé, Reineke David, Pilgrim Thomas, Windecker Stephan, Wenaweser Peter Martin, Wild Mirjam G

机构信息

Department of Cardiology, Bern University Hospital, Bern, Switzerland.

Department of Cardiac Surgery, Bern University Hospital, Bern, Switzerland.

出版信息

Front Cardiovasc Med. 2023 Jan 9;9:1026230. doi: 10.3389/fcvm.2022.1026230. eCollection 2022.

DOI:10.3389/fcvm.2022.1026230

PMID:36698931

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9870052/

Abstract

OBJECTIVES

The objective of this study was to characterize a population of patients with severe tricuspid regurgitation (TR) evaluated at a tertiary care center, assess mid-term clinical outcomes, and identify prognostic factors.

BACKGROUND

The impact of TR on morbidity and mortality is increasingly recognized. Clinical characteristics and long-term outcomes of patients suffering from TR remain unclear.

METHODS

This is a retrospective observational single-center study from a tertiary care hospital including patients with echocardiographic diagnosis of severe TR between January 2017 and December 2018. We used the Kaplan-Meier method to estimate survival for up to 4 years. After excluding patients with tricuspid valve (TV) intervention and surgery during follow-up, a multivariate analysis was performed to assess predictors of 2-year mortality using the Cox regression model.

RESULTS

A total of 278 patients (mean age 74.9 ± 13.7 years, 47.8% female) with severe TR were included in the study. The majority (83.1%; = 231) had secondary TR. Comorbidities such as atrial fibrillation (AFib) (68.0%; = 189), severe renal failure (44.2%; = 123), pulmonary hypertension (PHT) (80.9%; = 225), and right ventricular (RV) dysfunction (59.7%; = 166) were highly prevalent. More than half of patients with a cardiac implantable electronic device (CIED) (54.3%; = 44) showed echocardiographic signs of lead-leaflet interaction causing or contributing to TR. The estimated 2- and 4-year all-cause mortality was 50 and 69%, respectively. Using multivariate analysis, age, severe renal failure, heart failure with reduced ejection fraction (HFrEF), and vena contracta width ≥14 mm were identified as predictors of 2-year mortality. Nine percent ( = 25) of the study cohort underwent transcatheter or surgical treatment for TR during follow-up.

CONCLUSION

Our study shows the high burden of morbidity and the dismal survival of patients with severe TR. It also highlights the extent of the therapeutic need, since the vast majority of patients were left untreated. Additionally, CIED RV lead-associated TR was prevalent suggesting a need for more attention in clinical routine and research.

摘要

目的

本研究的目的是对在三级医疗中心评估的重度三尖瓣反流（TR）患者群体进行特征描述，评估中期临床结局，并确定预后因素。

背景

TR对发病率和死亡率的影响日益受到认可。TR患者的临床特征和长期结局仍不明确。

方法

这是一项来自三级医疗医院的回顾性观察单中心研究，纳入了2017年1月至2018年12月期间经超声心动图诊断为重度TR的患者。我们使用Kaplan-Meier方法估计长达4年的生存率。在排除随访期间接受三尖瓣（TV）干预和手术的患者后，使用Cox回归模型进行多变量分析以评估2年死亡率的预测因素。

结果

本研究共纳入278例重度TR患者（平均年龄74.9±13.7岁，47.8%为女性）。大多数患者（83.1%；n = 231）为继发性TR。合并症如心房颤动（AFib）（68.0%；n = 189）、严重肾衰竭（44.2%；n = 123）、肺动脉高压（PHT）（80.9%；n = 225）和右心室（RV）功能障碍（59.7%；n = 166）非常普遍。超过一半的心脏植入式电子设备（CIED）患者（54.3%；n = 44）表现出超声心动图上导线与瓣叶相互作用导致或促成TR的迹象。估计的2年和4年全因死亡率分别为50%和69%。通过多变量分析，年龄、严重肾衰竭、射血分数降低的心力衰竭（HFrEF）和缩流宽度≥14 mm被确定为2年死亡率的预测因素。9%（n = 25）的研究队列在随访期间接受了TR的经导管或手术治疗。