Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Am J Cardiol. 2023 Oct 1;204:320-324. doi: 10.1016/j.amjcard.2023.07.107. Epub 2023 Aug 9.
Tricuspid regurgitation (TR) is a frequent valvular pathology and when significant, may cause systemic venous congestion (SC). The right atrium (RA) is an intermediate structure between the tricuspid valve and the venous system and its role in SC is not yet defined. A total of 116 patients with a measurable TR effective regurgitant orifice area (EROA) and regurgitant volume (RVol) were selected from 2020 to 2022. SC was estimated by echocardiography using inferior vena cava diameter and estimated right atrial pressure (eRAP) and by clinical congestive features. TR grade was mild in 23 patients (20%), moderate in 53 patients (46%), and severe in 40 patients (34%). There was a significant decrease in RA function measured by strain with increasing TR severity (p <0.001). There was a marked difference in RA strain between the groups with eRAP >10 and ≤10 mm Hg (25 ± 11% vs 11 ± 7%, p <0.0001). Variables independently associated with inferior vena cava diameter were RA strain (β -0.532, p <0.001), RA volume indexed (β 0.249, p = 0.002), RVol (β 0.229, p = 0.005) and EROA (β 0.185, p = 0.016), and independently associated with eRAP >10 mm Hg were EROA (odds ratio [OR] 1.024, 95% confidence interval [CI] 1.002 to 1.046), RVol (OR 1.039, 95% CI 1.007 to 1.072) and RA strain (OR 0.863, 95% CI 0.794 to 0.940). The addition of RA strain to models containing EROA or RVol significantly improved the power of the model. RA strain was independently associated with the presence of 3 or more congestive features. In conclusion, echocardiographic and clinical signs of SC are frequent in higher degrees of TR, and RA function seems to play a key role in modulating the downstream effect of TR.
三尖瓣反流 (TR) 是一种常见的瓣膜疾病，当病情严重时，可能会导致全身静脉充血 (SC)。右心房 (RA) 是三尖瓣和静脉系统之间的中间结构，但其在 SC 中的作用尚未确定。从 2020 年到 2022 年，共选择了 116 名可测量三尖瓣有效反流口面积 (EROA) 和反流容积 (RVol) 的患者。通过超声心动图测量下腔静脉直径和估计右心房压 (eRAP) 以及临床充血特征来估计 SC。TR 分级为轻度 23 例 (20%)、中度 53 例 (46%)、重度 40 例 (34%)。随着 TR 严重程度的增加，通过应变测量的 RA 功能显著下降 (p<0.001)。eRAP>10 和≤10mmHg 两组之间的 RA 应变差异显著 (25±11% vs 11±7%，p<0.0001)。与下腔静脉直径独立相关的变量是 RA 应变 (β-0.532，p<0.001)、RA 容积指数 (β0.249，p=0.002)、RVol (β0.229，p=0.005) 和 EROA (β0.185，p=0.016)，与 eRAP>10mmHg 独立相关的是 EROA (比值比 [OR] 1.024，95%置信区间 [CI] 1.002 至 1.046)、RVol (OR 1.039，95%CI 1.007 至 1.072) 和 RA 应变 (OR 0.863，95%CI 0.794 至 0.940)。将 RA 应变添加到包含 EROA 或 RVol 的模型中显著提高了模型的能力。RA 应变与存在 3 个或更多充血特征独立相关。总之，TR 程度较高时，超声心动图和 SC 的临床征象较为常见，而 RA 功能似乎在调节 TR 的下游效应中发挥关键作用。
