Margonato Davide, Ingallina Giacomo, Belli Martina, Tavernese Annamaria, Ricchetti Gianluca, Ancona Francesco, Stella Stefano, Biondi Federico, Fiore Giorgio, De Bonis Michele, Maisano Francesco, Topilsky Yan, Agricola Eustachio
Cardiovascular Imaging Unit, Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cardiac Surgery Unit, Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Heliyon. 2024 Jul 19;10(14):e34874. doi: 10.1016/j.heliyon.2024.e34874. eCollection 2024 Jul 30.
We aimed to assess the characteristics, management and long-term prognosis of a cohort of patients with multiple valvular disease, focusing on the context of severe mitral or aortic disease with concomitant significant tricuspid regurgitation (TR).
After using a propensity score matching for age, 975 patients with ≥ moderate TR, diagnosed at our centers from 2012 to 2020, were included and divided in four groups, including isolated TR patients as reference group. Primary endpoint was all-cause death (ACD), secondary endpoint was the composite of heart failure (HF) hospitalization + any valvular intervention.
Patients with isolated TR (356, 37 %) had more history of atrial fibrillation and were more often asymptomatic and with preserved left-ventricular ejection fraction (LVEF). Patients with severe mitral regurgitation (MR) + TR (466, 48 %) showed higher rates of concomitant coronary artery disease, advanced functional class symptoms and larger left atrial volumes. Severe aortic stenosis (AS) patients (131, 13 %) were older, with more comorbidities and lower LVEF. Patients with severe aortic regurgitation and TR (22, 2 %) were younger, with larger LV dimensions and higher pulmonary arterial pressures.After a median follow-up of 2.8 years, both endpoints were univariably more frequent in patients with severe AS + TR (all p < 0.001), but after comprehensive adjustment difference in the primary endpoint became insignificant, underscoring the serious outcomes of all significant TR groups significantly. Overall, in 44 (5 %) patients tricuspid intervention was performed, with no differences between groups in term of frequency of concomitant or staged tricuspid valve surgical treatment.
In the context of severe left-sided VD, concomitant significant TR is common, and each subtype presents with different clinical and echocardiographic features: patients with severe AS and TR have considerable worse prognosis, although comprehensive adjustment reflected the poor outcomes affecting all types of patients with significant TR. In this scenario, TR was profoundly undertreated.
我们旨在评估一组多瓣膜病患者的特征、管理及长期预后，重点关注重度二尖瓣或主动脉瓣疾病合并显著三尖瓣反流（TR）的情况。
在对年龄进行倾向评分匹配后，纳入了975例于2012年至2020年在我们中心诊断为≥中度TR的患者，并将其分为四组，包括孤立性TR患者作为参照组。主要终点为全因死亡（ACD），次要终点为心力衰竭（HF）住院 + 任何瓣膜干预的复合终点。
孤立性TR患者（356例，37%）房颤病史更多，且更常无症状，左心室射血分数（LVEF）保留。重度二尖瓣反流（MR） + TR患者（466例，48%）合并冠状动脉疾病、高级功能分级症状的发生率更高，左心房容积更大。重度主动脉瓣狭窄（AS）患者（131例，13%）年龄更大，合并症更多，LVEF更低。重度主动脉瓣反流和TR患者（22例，2%）更年轻，左心室尺寸更大，肺动脉压更高。中位随访2.8年后，两个终点在重度AS + TR患者中均单变量更常见（所有p < 0.001），但在全面调整后，主要终点的差异变得不显著，显著强调了所有显著TR组的严重结局。总体而言，44例（5%）患者进行了三尖瓣干预，各组在同期或分期三尖瓣手术治疗频率方面无差异。
在重度左侧瓣膜病的情况下，合并显著TR很常见，且每种亚型具有不同的临床和超声心动图特征：重度AS和TR患者的预后相当差，尽管全面调整反映了影响所有类型显著TR患者的不良结局。在这种情况下，TR的治疗严重不足。
