Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
IT Systems and Communications, Medical University of Vienna, Vienna, Austria.
Eur J Heart Fail. 2023 Jun;25(6):857-867. doi: 10.1002/ejhf.2858. Epub 2023 May 1.
Tricuspid regurgitation secondary to heart failure (HF) is common with considerable impact on survival and hospitalization rates. Currently, insights into epidemiology, impact, and treatment of secondary tricuspid regurgitation (sTR) across the entire HF spectrum are lacking, yet are necessary for healthcare decision-making.
This population-based study included data from 13 469 patients with HF and sTR from the Viennese community over a 10-year period. The primary outcome was long-term mortality. Overall, HF with preserved ejection fraction was the most frequent (57%, n = 7733) HF subtype and the burden of comorbidities was high. Severe sTR was present in 1514 patients (11%), most common among patients with HF with reduced ejection fraction (20%, n = 496). Mortality of patients with sTR was higher than expected survival of sex- and age-matched community and independent of HF subtype (moderate sTR: hazard ratio [HR] 6.32, 95% confidence interval [CI] 5.88-6.80, p < 0.001; severe sTR: HR 9.04; 95% CI 8.27-9.87, p < 0.001). In comparison to HF and no/mild sTR patients, mortality increased for moderate sTR (HR 1.58, 95% CI 1.48-1.69, p < 0.001) and for severe sTR (HR 2.19, 95% CI 2.01-2.38, p < 0.001). This effect prevailed after multivariate adjustment and was similar across all HF subtypes. In subgroup analysis, severe sTR mortality risk was more pronounced in younger patients (<70 years). Moderate and severe sTR were rarely treated (3%, n = 147), despite availability of state-of-the-art facilities and universal health care.
Secondary tricuspid regurgitation is frequent, increasing with age and associated with excess mortality independent of HF subtype. Nevertheless, sTR is rarely treated surgically or percutaneously. With the projected increase in HF prevalence and population ageing, the data suggest a major burden for healthcare systems that needs to be adequately addressed. Low-risk transcatheter treatment options may provide a suitable alternative.
心力衰竭（HF）继发三尖瓣反流（sTR）较为常见，对生存率和住院率有重大影响。目前，HF 全谱范围内 sTR 的流行病学、影响和治疗的相关信息尚不完善，但对于医疗保健决策是必要的。
这项基于人群的研究纳入了 10 年间来自维也纳社区的 13469 例 HF 伴 sTR 患者的数据。主要终点是长期死亡率。HF 患者中射血分数保留型心衰（HFpEF）最常见（57%，n=7733），合并症负担较重。1514 例（11%）患者存在严重 sTR，其中射血分数降低型心衰（HFrEF）患者最为常见（20%，n=496）。sTR 患者的死亡率高于预期的同龄、同性别社区人群的生存率，且与 HF 亚型无关（中度 sTR：危险比[HR]6.32，95%置信区间[CI]5.88-6.80，p<0.001；重度 sTR：HR 9.04；95%CI 8.27-9.87，p<0.001）。与 HF 伴无/轻度 sTR 患者相比，中度 sTR（HR 1.58，95%CI 1.48-1.69，p<0.001）和重度 sTR（HR 2.19，95%CI 2.01-2.38，p<0.001）患者的死亡率增加。多变量调整后仍存在此效应，且在所有 HF 亚型中相似。亚组分析显示，年龄较轻（<70 岁）的重度 sTR 患者的死亡率风险更高。尽管有先进的设施和全民医疗保健，但中度和重度 sTR 的治疗率（3%，n=147）却很低。鉴于 HF 患病率和人口老龄化的预期增长，这些数据表明 HF 患者需要对医疗保健系统进行充分的治疗，这将给医疗系统带来巨大负担。低风险的经导管治疗选择可能是一种合适的替代方案。
