Ogawa Mana, Kuwajima Ken, Yamane Takafumi, Hasegawa Hiroko, Yagi Nobuichiro, Shiota Takahiro
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Front Cardiovasc Med. 2023 Sep 21;10:1188005. doi: 10.3389/fcvm.2023.1188005. eCollection 2023.
With the aging population and advanced catheter-based therapy, isolated tricuspid regurgitation (TR) with atrial fibrillation (AF) has gained increased attention; however, data on the prognostic effect of isolated TR with AF are limited because of the small number of patients among those with severe TR. Recently, right ventricular (RV) longitudinal strain by two-dimensional speckle-tracking echocardiography has been reported as an excellent indicator of RV dysfunction in severe TR. However, the prognostic implications of RV longitudinal strain in isolated severe TR associated with AF remain unclear. Therefore, this study aimed to reveal the prognostic value of this index in this population.
We retrospectively studied patients with severe isolated TR associated with AF in the absence of other etiologies in the Cedars-Sinai Medical Center between April 2015 and March 2018. Baseline clinical and echocardiographic data were studied including RV systolic function evaluated by RV free wall longitudinal strain (FWLS) and conventional parameters. All-cause death was defined as the primary endpoint.
In total, 53 patients (median age, 85 years; female, 60%) with a median follow-up of 433 (60-1567) days were included. Fourteen patients (26%) died, and 66% had right heart failure (RHF) symptoms. By multivariable analysis, reduced RVFWLS was independently associated with all-cause death. Patients with RVFWLS of ≤18% had higher risk of all-cause death adjusted for age (log-rank = 0.030, adjusted hazard ratio 4.00, 95% confidence interval, 1.11-14.4; = 0.034). When patients were stratified into four groups by RHF symptoms and RVFWLS, the group with symptomatic and reduced RVFWLS had the worst outcome.
Reduced RVFWLS was independently associated with all-cause death in patients with isolated severe TR and AF. Our subset classification showed the worst outcome from the combination of RHF symptoms and reduced RVFWLS.
随着人口老龄化和先进的导管介入治疗技术的发展，孤立性三尖瓣反流（TR）合并心房颤动（AF）越来越受到关注；然而，由于严重TR患者数量较少，关于孤立性TR合并AF的预后影响的数据有限。最近，二维斑点追踪超声心动图测量的右心室（RV）纵向应变已被报道为严重TR中RV功能障碍的一个优秀指标。然而，RV纵向应变在孤立性严重TR合并AF中的预后意义仍不明确。因此，本研究旨在揭示该指标在这一人群中的预后价值。
我们回顾性研究了2015年4月至2018年3月在雪松西奈医疗中心患有严重孤立性TR合并AF且无其他病因的患者。研究了基线临床和超声心动图数据，包括通过RV游离壁纵向应变（FWLS）和传统参数评估的RV收缩功能。全因死亡被定义为主要终点。
共纳入53例患者（中位年龄85岁；女性占60%），中位随访时间为433（60 - 1567）天。14例患者（26%）死亡，66%有右心衰竭（RHF）症状。通过多变量分析，RVFWLS降低与全因死亡独立相关。RVFWLS≤18%的患者在调整年龄后全因死亡风险更高（对数秩检验=0.030，调整后风险比4.00，95%置信区间，1.11 - 14.4；P = 0.034）。当根据RHF症状和RVFWLS将患者分为四组时，有症状且RVFWLS降低的组预后最差。
在孤立性严重TR合并AF的患者中，RVFWLS降低与全因死亡独立相关。我们的亚组分类显示，RHF症状和RVFWLS降低相结合的情况预后最差。
Zotero 插件
