Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Rev Esp Cardiol (Engl Ed). 2023 Nov;76(11):845-851. doi: 10.1016/j.rec.2023.02.008. Epub 2023 Mar 9.
Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Clinical evaluation of TR patients is challenging. Our aim was to establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its prognostic performance.
We included patients with isolated TR that was at least severe and without previous episodes of heart failure (HF) who were assessed in the heart valve clinic. We registered signs and symptoms of asthenia, ankle swelling, abdominal pain or distention and/or anorexia and followed up the patients every 6 months. The 4A classification ranged from A0 (no A) to A3 (3 or 4 As present). We defined a combined endpoint consisting of hospital admission due to right HF or cardiovascular mortality.
We included 135 patients with significant TR between 2016 and 2021 (69% females, mean age 78±7 years). During a median follow-up of 26 [IQR, 10-41] months, 39% (n=53) patients had the combined endpoint: 34% (n=46) were admitted for HF and 5% (n=7) died. At baseline, 94% of the patients were in NYHA I or II, while 24% were in classes A2 or A3. The presence of A2 or A3 conferred a high incidence of events. The change in 4A class remained an independent marker of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class, 1.95 [1.37-2.77]; P<.001).
This study reports a novel clinical classification specifically for patients with TR that is based on signs and symptoms of right HF and has prognostic value for events.
严重三尖瓣反流（TR）与发病率和死亡率增加有关。TR 患者的临床评估具有挑战性。我们的目的是建立一种新的专门针对 TR 患者的临床分类，即 4A 分类，并评估其预后性能。
我们纳入了至少为重度且无心力衰竭（HF）既往发作的孤立性 TR 患者，这些患者在心脏瓣膜门诊接受评估。我们记录了乏力、踝肿胀、腹痛或腹胀和/或食欲不振的体征和症状，并每 6 个月对患者进行随访。4A 分类范围从 A0（无 A）到 A3（存在 3 或 4 个 A）。我们定义了一个联合终点，包括因右心衰住院或心血管死亡。
我们纳入了 2016 年至 2021 年间 135 例有明显 TR 的患者（69%为女性，平均年龄 78±7 岁）。在中位数为 26 [IQR，10-41]个月的随访期间，39%（n=53）的患者出现了联合终点：34%（n=46）因 HF 住院，5%（n=7）死亡。基线时，94%的患者处于 NYHA I 或 II 级，而 24%的患者处于 A2 或 A3 级。A2 或 A3 的存在预示着较高的事件发生率。4A 级别的变化仍然是 HF 和心血管死亡的独立标志物（4A 级别的每单位变化的调整 HR，1.95[1.37-2.77]；P<.001）。
本研究报告了一种新的专门针对 TR 患者的临床分类，该分类基于右心衰的体征和症状，对事件具有预后价值。
