Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China.
BMC Cardiovasc Disord. 2024 Mar 12;24(1):149. doi: 10.1186/s12872-024-03805-2.
Tricuspid regurgitation (TR) is a prevalent disease that triggers systemic pathological changes including cardiac, respiratory, hepatic and digestive, hematopoietic, renal and skin issues. The burden of extra-cardiac manifestations has not been well described in TR patients and the clinical impact is unknown.
Patients with severe or more-than-severe TR during hospitalization, who did not have any previous cardiac procedures, hemodynamically significant congenital heart disease or concomitant severe aortic or mitral valve disease, were retrospectively analyzed. Pre-specified criteria and diagnosis of baseline characteristics were used to evaluate the presence of extra-cardiac manifestations secondary to TR after excluding comorbidities that may also lead to corresponding abnormalities. Extra-cardiac involvements encompass respiratory, hepatic and, digestive, renal, hematopoietic and dermatic system. Staging criteria are defined as no extra-cardiac system involvement in Stage 1, one in Stage 2, at least two extra-cardiac involvements in Stage 3 and any end-stage organ failure in Stage 4. A telephone follow-up was conducted to record the composite endpoint namely all-cause death or cardiac rehospitalization after the index hospitalization.
A total of 258 patients were identified with a median age of 73 (interquartile range [IQR]: 62-83) years and 52.3% were female. Severe TR and more-than-severe TR patients accounted for 92.6% and 7.4% of the cohort. There were 20.5%, 27.5%, 37.6% and 14.3% of patients from Stage 1 to 4 respectively. The follow-up time was at a median of 251 (IQR: 183-324) days. TR Patients in Stage 3&4 were at an increased risk with borderline statistical significance to experience the composite endpoint compared to patients in Stage 1&2 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.0 to 3.7, P = 0.049).
Approximately half of patients with at least severe TR presented with two or more extra-cardiac systemic manifestations, which may incur a 1.9-fold higher risk of all-cause death or cardiac rehospitalization than TR patients with one or less extra-cardiac involvement.
三尖瓣反流（TR）是一种常见疾病，可引发包括心脏、呼吸、肝和消化、血液、肾脏和皮肤等全身系统的病理变化。TR 患者的心脏外表现负担尚未得到充分描述，其临床影响也尚不清楚。
回顾性分析了住院期间患有严重或重度以上 TR、无任何先前心脏手术、有血流动力学意义的先天性心脏病或同时伴有严重主动脉瓣或二尖瓣疾病的患者。使用预先指定的标准和基线特征诊断，在排除可能导致相应异常的合并症后，评估 TR 引起的心脏外表现。心脏外表现包括呼吸、肝和消化、肾脏、血液和皮肤系统。分期标准定义为无心脏外系统受累为 1 期，有 1 个系统受累为 2 期，有 2 个及以上系统受累为 3 期，任何终末期器官衰竭为 4 期。通过电话随访记录复合终点事件，即索引住院后全因死亡或心脏再入院。
共纳入 258 例患者，中位年龄为 73 岁（四分位距 [IQR]：62-83 岁），52.3%为女性。严重 TR 和重度以上 TR 患者分别占队列的 92.6%和 7.4%。1 期至 4 期患者分别占 20.5%、27.5%、37.6%和 14.3%。中位随访时间为 251 天（IQR：183-324 天）。与 1 期和 2 期患者相比，3 期和 4 期患者发生复合终点事件的风险略有增加，但具有统计学意义（比值比 [OR] 1.9，95%置信区间 [CI] 1.0 至 3.7，P=0.049）。
至少严重 TR 的患者中约有一半存在两种或更多种心脏外全身表现，其全因死亡或心脏再入院风险比有 1 种或更少心脏外表现的 TR 患者高 1.9 倍。
