Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania.
Eur J Heart Fail. 2023 Jul;25(7):1061-1071. doi: 10.1002/ejhf.2929. Epub 2023 Jun 26.
Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum.
The ESC-HFA EORP HF Long-Term Registry is a prospective, multicentre, observational study including patients with HF and 1-year follow-up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60-0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41-0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36-0.49), and combined MR/TR (OR 0.59; 95% 0.50-0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61-2.33). All-cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR.
In a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome.
二尖瓣反流（MR）和三尖瓣反流（TR）在心力衰竭（HF）患者中较为常见。本研究旨在调查整个 HF 谱中单纯或联合 MR 和 TR 的患者的患病率、临床特征和结局。
ESC-HFA EORP HF 长期注册研究是一项前瞻性、多中心、观察性研究，纳入 HF 患者并随访 1 年。排除主动脉瓣疾病患者，并根据单纯或联合中重度 MR 和 TR 进行分层。在 11298 例患者中，7541 例（67%）无 MR/TR，1931 例（17%）单纯 MR，616 例（5.5%）单纯 TR，1210 例（11%）联合 MR/TR。基线特征在 MR/TR 分类中分布不同。与射血分数降低性 HF 相比，射血分数轻度降低性 HF 与单纯性 MR 的风险降低相关（比值比 [OR] 0.69；95%置信区间 [CI] 0.60-0.80），且联合性 MR/TR 的风险明显降低（OR 0.51；95% CI 0.41-0.62）。射血分数保留性 HF（HFpEF）与单纯性 MR（OR 0.42；95% CI 0.36-0.49）和联合性 MR/TR（OR 0.59；95% CI 0.50-0.70）的风险明显降低，但单纯性 TR 的风险明显增加（OR 1.94；95% CI 1.61-2.33）。所有原因死亡、心血管死亡、HF 住院和联合结局在联合性 MR/TR、单纯性 TR 和单纯性 MR 中比无 MR/TR 更常见。单纯性 TR 和联合性 MR/TR 的发生率最高。
在 HF 门诊患者的大样本中，单纯性和联合性 MR 和 TR 的患病率相对较高。单纯性 TR 由 HFpEF 驱动，且预后出乎意料地差。
