Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Open Heart. 2023 Sep;10(2). doi: 10.1136/openhrt-2023-002295.
A substantial proportion of patients with rheumatic heart disease (RHD) have tricuspid regurgitation (TR). This study aimed to identify the impact of functional TR on clinical outcomes and predictors of progression in a large population of patients with RHD.
A total of 645 patients with RHD were enrolled, mean age of 47±12 years, 85% female. Functional TR was graded as absent, mild, moderate or severe. TR progression was defined either as worsening of TR degree from baseline to the last follow-up echocardiogram or severe TR at baseline that required surgery or died. Incidence of TR progression was estimated accounting for competing risks.
Functional TR was absent in 3.4%, mild in 83.7%, moderate in 8.5% and severe in 4.3%. Moderate and severe functional TR was associated with adverse outcome (HR 1.91 (95% CI 1.15 to 3.2) for moderate, and 2.30 (95% CI 1.28 to 4.13) for severe TR, after adjustment for other prognostic variables. Event-free survival rate at 3-year follow-up was 91%, 72% and 62% in patients with no or mild, moderate and severe TR, respectively. During mean follow-up of 4.1 years, TR progression occurred in 83 patients (13%) with an overall incidence of 3.7 events (95% CI 2.9 to 4.5) per 100 patient-years. In the Cox model, age (HR 1.71, 95% CI 1.34 to 2.17), New York Heart Association functional class III/IV (HR 2.57, 95% CI 1.54 to 4.30), right atrial area (HR 1.52, 95% CI 1.10 to 2.10) and right ventricular (RV) dysfunction (HR 2.02, 95% CI 1.07 to 3.84) were predictors of TR progression. By considering competing risk, the effect of RV dysfunction on TR progression risk was attenuated.
In patients with RHD, functional TR was frequent and associated with adverse outcomes. TR may progress over time, mainly related to right-sided cardiac chambers remodelling.
相当一部分风湿性心脏病（RHD）患者存在三尖瓣反流（TR）。本研究旨在确定在大量 RHD 患者中，功能性 TR 对临床结局的影响及其进展的预测因素。
共纳入 645 例 RHD 患者，平均年龄 47±12 岁，85%为女性。功能性 TR 分级为无、轻度、中度或重度。TR 进展定义为基线至最后一次超声心动图随访时 TR 程度恶化，或基线时出现需要手术或死亡的重度 TR。考虑竞争风险估计 TR 进展的发生率。
无功能性 TR 占 3.4%，轻度占 83.7%，中度占 8.5%，重度占 4.3%。中度和重度功能性 TR 与不良结局相关（校正其他预后变量后，中度 TR 的 HR 为 1.91（95%CI 1.15 至 3.2），重度 TR 的 HR 为 2.30（95%CI 1.28 至 4.13））。无或轻度、中度和重度 TR 患者的 3 年随访时无事件生存率分别为 91%、72%和 62%。在平均 4.1 年的随访期间，83 例患者（13%）发生 TR 进展，总发生率为每 100 患者-年 3.7 例（95%CI 2.9 至 4.5）。在 Cox 模型中，年龄（HR 1.71，95%CI 1.34 至 2.17）、纽约心脏协会功能分级 III/IV 级（HR 2.57，95%CI 1.54 至 4.30）、右心房面积（HR 1.52，95%CI 1.10 至 2.10）和右心室（RV）功能障碍（HR 2.02，95%CI 1.07 至 3.84）是 TR 进展的预测因素。考虑竞争风险后，RV 功能障碍对 TR 进展风险的影响减弱。
在 RHD 患者中，功能性 TR 很常见，与不良结局相关。TR 可能随时间进展，主要与右侧心腔重构有关。
