Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy (D.C., D.S. M.P., S.C., D.B., G.S., J.G.R., G.B., M.M., A.A., G.S.).
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (D.S.).
Circ Cardiovasc Imaging. 2023 Jul;16(7):566-576. doi: 10.1161/CIRCIMAGING.122.014988. Epub 2023 Jun 29.
Tricuspid regurgitation (TR) is common in chronic heart failure (HF) and is associated with negative prognosis. However, evidence on prognostic implications of TR in acute HF is lacking. We sought to investigate the association between TR and mortality and the interaction with pulmonary hypertension (PH) in patients admitted for acute HF.
We enrolled 1176 consecutive patients with a primary diagnosis of acute HF and with available noninvasive estimation of TR and pulmonary arterial systolic pressure.
Moderate-severe TR was present in 352 patients (29.9%) and was associated with older age and more comorbidities. The prevalence of PH (ie, pulmonary arterial systolic pressure >40 mm Hg), right ventricular dysfunction, and mitral regurgitation was higher in moderate-severe TR. At 1 year, 184 (15.6%) patients died. Moderate-severe TR was associated with higher 1-year mortality risk after adjustment for other echocardiographic parameters (pulmonary arterial systolic pressure, left ventricle ejection fraction, right ventricular dysfunction, mitral regurgitation, left and right atrial indexed volumes; hazard ratio, 1.718; =0.009), and the association with outcome was maintained when clinical variables (eg, natriuretic peptides, serum creatinine and urea, systolic blood pressure, atrial fibrillation) were added to the multivariable model (hazard ratio, 1.761; =0.024). The association between moderate-severe TR and outcome was consistent in patients with versus without PH, with versus without right ventricular dysfunction, and with versus without left ventricle ejection fraction <50%. Patients with coexistent moderate-severe TR and PH had 3-fold higher 1-year mortality risk compared with patients with no TR or PH (hazard ratio, 3.024; <0.001).
In patients hospitalized for acute HF, the severity of TR is associated with 1-year survival, regardless of the presence of PH. The coexistence of moderate-severe TR and estimated PH was associated with a further increase in mortality risk. Our data must be interpreted in the context of potential underestimation of pulmonary arterial systolic pressure in patients with severe TR.
三尖瓣反流（TR）在慢性心力衰竭（HF）中很常见，与不良预后相关。然而，急性 HF 中 TR 预后意义的证据尚缺乏。我们旨在研究急性 HF 患者中 TR 与死亡率的相关性，以及与肺动脉高压（PH）的相互作用。
我们纳入了 1176 例因急性 HF 住院且可进行 TR 和肺动脉收缩压无创评估的连续患者。
中重度 TR 存在于 352 例患者（29.9%）中，与年龄较大和更多合并症相关。中重度 TR 患者中 PH（即肺动脉收缩压>40mmHg）、右心室功能障碍和二尖瓣反流的患病率更高。在 1 年时，有 184 例（15.6%）患者死亡。校正其他超声心动图参数（肺动脉收缩压、左心室射血分数、右心室功能障碍、二尖瓣反流、左心房和右心房指数容积）后，中重度 TR 与 1 年死亡率风险增加相关（风险比，1.718；=0.009），并且当将临床变量（如利钠肽、血清肌酐和尿素、收缩压、心房颤动）加入多变量模型后，这种与结局的相关性仍保持（风险比，1.761；=0.024）。在有或无 PH、有或无右心室功能障碍、有或无左心室射血分数<50%的患者中，中重度 TR 与结局的相关性一致。与无 TR 或 PH 的患者相比，同时存在中重度 TR 和 PH 的患者 1 年死亡率风险增加 3 倍（风险比，3.024；<0.001）。
在因急性 HF 住院的患者中，TR 的严重程度与 1 年生存率相关，无论是否存在 PH。中重度 TR 和估计 PH 的共存与死亡率风险的进一步增加相关。我们的数据必须在严重 TR 患者肺动脉收缩压可能被低估的情况下进行解释。
