Bohbot Yohann, Tordjman Léa, Dreyfus Julien, Le Tourneau Thierry, Lavie-Badie Yoan, Selton-Suty Christine, Elegamandji Benjamin, L'official Guillaume, Fraix Antoine, Aghezzaf Samy, Turgeon Pierre Yves, Messika Zeitoun David, Enriquez-Sarano Maurice, Coisne Augustin, Donal Erwan, Tribouilloy Christophe
Department of Cardiology, Amiens University Hospital, Amiens, France.
UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
Front Cardiovasc Med. 2023 Apr 27;10:1090572. doi: 10.3389/fcvm.2023.1090572. eCollection 2023.
Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.
In this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.
The relationship between the EROA and TCG was poor (=0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA <60 mm vs. ≥60 mm (68 ± 3% vs. 64 ± 5%, = 0.89). A TCG ≥10 mm was associated with lower four-year survival than a TCG <10 mm (53 ± 7% vs. 69 ± 3%, < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95% CI] = 1.47[1.13-2.21], = 0.019) and cardiovascular mortality (adjusted HR[95% CI] = 2.12[1.33-3.25], = 0.001), whereas an EROA ≥60 mm was not associated with all-cause or cardiovascular mortality (adjusted HR[95% CI]: 1.16[0.81-1.64], = 0.416, and adjusted HR[95% CI]: 1.07[0.68-1.68], = 0.784, respectively).
The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated significant functional TR.
基于有效反流口面积（EROA）或三尖瓣瓣叶对合间隙（TCG），已经提出了多种关于极重度（VS）三尖瓣反流（TR）的定义。由于EROA存在固有的局限性，我们推测TCG更适合用于定义极重度TR并预测预后。
在这项法国多中心回顾性研究中，根据欧洲心血管影像学会的建议，我们纳入了606例患有≥中重度孤立性功能性TR（无结构性瓣膜病或明显心脏病因）的患者。根据EROA（≥60 mm），然后再根据TCG（≥10 mm）将患者进一步分层为极重度TR。主要终点是全因死亡率，次要终点是心血管死亡率。
EROA与TCG之间的关系较差（=0.22），尤其是当缺损较大时。EROA <60 mm与≥60 mm的患者4年生存率相当（68±3%对64±5%，=0.89）。TCG≥10 mm的患者4年生存率低于TCG <10 mm的患者（53±7%对69±3%，<0.001）。在对包括合并症、症状、利尿剂剂量以及右心室扩张和功能障碍等协变量进行调整后，TCG≥10 mm仍然独立地与较高的全因死亡率（调整后HR[95%CI]=1.47[1.13 - 2.21]，=0.019）和心血管死亡率（调整后HR[95%CI]=2.12[1.33 - 3.25]，=0.001）相关，而EROA≥60 mm与全因或心血管死亡率无关（调整后HR[95%CI]：1.16[0.81 - 1.64]，=0.416，以及调整后HR[95%CI]：1.07[0.68 - 1.68]，=0.784）。
TCG与EROA之间的相关性较弱，且随着缺损大小增加而降低。TCG≥10 mm与全因死亡率和心血管死亡率增加相关，应将其用于定义孤立性显著功能性TR中的极重度TR。
