Ueyama Hiroki A, Licitra Giancarlo, Gleason Patrick T, Behbahani-Nejad Omid, Modi Roshan, Rajagopal Dhiren, Byku Isida, Xie Joe X, Greenbaum Adam B, Paone Gaetano, Keeling W Brent, Grubb Kendra J, Hanzel George S, Devireddy Chandan M, Block Peter C, Babaliaros Vasilis C
Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
Am J Cardiol. 2024 Jun 1;220:84-91. doi: 10.1016/j.amjcard.2024.03.036. Epub 2024 Apr 9.
Development of functional tricuspid regurgitation (TR) because of chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes after transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR. This was a single-center, retrospective analysis of patients who received valve-in-valve or valve-in-ring TMVR between 2012 and 2022. Patients were categorized into none/mild TR and moderate/severe TR based on baseline echocardiography. The primary outcome was 3 years all-cause death and the secondary outcomes were in-hospital events. Of the 135 patients who underwent TMVR, 64 (47%) exhibited none/mild TR at baseline, whereas 71 (53%) demonstrated moderate/severe TR. There were no significant differences in in-hospital events between the groups. At 3 years, the moderate/severe TR group exhibited a significantly increased risk of all-cause death (adjusted hazard ratio 3.37, 95% confidence interval 1.35 to 8.41, p = 0.009). When patients with baseline moderate/severe TR were stratified by echocardiography at 30 days into improved (36%) and nonimproved (64%) TR groups, although limited by small sample size, there was no significant difference in 3-year all-cause mortality (p = 0.48). In conclusion, this study investigating the impact of baseline TR on clinical outcomes revealed that moderate/severe TR is prevalent in those who underwent TMVR and is an independent predictor of 3-year all-cause mortality. Earlier mitral valve intervention before the development of significant TR may play a pivotal role in improving outcomes after TMVR.
由于慢性二尖瓣疾病及随后的心力衰竭导致功能性三尖瓣反流（TR）的情况很常见。然而，TR对经导管二尖瓣置换术（TMVR）后临床结局的影响仍不明确。我们旨在评估基线TR对TMVR术后结局的影响。这是一项对2012年至2022年间接受瓣中瓣或瓣中环TMVR的患者进行的单中心回顾性分析。根据基线超声心动图将患者分为无/轻度TR组和中度/重度TR组。主要结局是3年全因死亡，次要结局是住院期间的事件。在接受TMVR的135例患者中，64例（47%）基线时表现为无/轻度TR，而71例（53%）表现为中度/重度TR。两组间住院期间事件无显著差异。3年时，中度/重度TR组全因死亡风险显著增加（调整后风险比3.37，95%置信区间1.35至8.41，p = 0.009）。当基线中度/重度TR的患者在30天时通过超声心动图分层为TR改善组（36%）和未改善组（64%）时，尽管受样本量小的限制，3年全因死亡率无显著差异（p = 0.48）。总之，这项研究调查了基线TR对临床结局的影响，结果显示中度/重度TR在接受TMVR的患者中很普遍，并且是3年全因死亡率的独立预测因素。在显著TR发生之前更早地进行二尖瓣干预可能在改善TMVR术后结局中起关键作用。
