心房性继发性三尖瓣反流：欧洲三尖瓣反流注册研究的见解
Atrial Secondary Tricuspid Regurgitation: Insights Into the EuroTR Registry.
作者信息
Stolz Lukas, Kresoja Karl-Patrik, von Stein Jennifer, Fortmeier Vera, Koell Benedikt, Rottbauer Wolfgang, Kassar Mohammad, Goebel Bjoern, Denti Paolo, Achouh Paul, Rassaf Tienush, Barreiro-Perez Manuel, Boekstegers Peter, Rück Andreas, Doldi Philipp M, Novotny Julia, Zdanyte Monika, Adamo Marianna, Vincent Flavien, Schlegel Philipp, von Bardeleben Ralph Stephan, Stocker Thomas J, Weckbach Ludwig T, Wild Mirjam G, Besler Christian, Brunner Stephanie, Toggweiler Stefan, Grapsa Julia, Patterson Tiffany, Thiele Holger, Kister Tobias, Tarantini Giuseppe, Masiero Giulia, De Carlo Marco, Sticchi Alessandro, Konstandin Mathias H, Van Belle Eric, Metra Marco, Geisler Tobias, Estévez-Loureiro Rodrigo, Luedike Peter, Karam Nicole, Maisano Francesco, Lauten Philipp, Praz Fabien, Kessler Mirjam, Kalbacher Daniel, Rudolph Volker, Iliadis Christos, Lurz Philipp, Hausleiter Jörg
机构信息
Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
出版信息
JACC Cardiovasc Interv. 2024 Dec 9;17(23):2781-2791. doi: 10.1016/j.jcin.2024.10.028.
BACKGROUND
Atrial secondary tricuspid regurgitation (A-STR) has been proposed as an important etiologic subentity of secondary tricuspid regurgitation (STR). Patients with A-STR are frequently treated using transcatheter tricuspid valve edge-to-edge repair (T-TEER).
OBJECTIVES
The aims of this study were to evaluate prevalence and outcomes following T-TEER for severe A-STR and to compare the results to patients with nonatrial STR.
METHODS
The study included patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry who underwent T-TEER for STR from 2016 until 2022. A-STR was defined as a ratio of end-systolic right atrial area to right ventricular area ≥1.5 in the presence of preserved right ventricular function (tricuspid annular plane systolic excursion >17 mm). The primary study endpoint was 2-year survival free from heart failure hospitalization. Secondary endpoints were 2-year survival, tricuspid regurgitation (TR) reduction at discharge and 1-year follow-up as well as changes in NYHA functional class.
RESULTS
This study included 641 patients (50% women) with a mean age of 79 ± 7 years. The overall prevalence of A-STR was 31% (n = 196). A-STR was associated with a higher prevalence of atrial fibrillation, less frequent comorbidities, better biventricular function, less leaflet tenting, and larger atria. Although TR severity was comparable at baseline, patients with A-STR had more effective procedural TR reduction (TR ≤2+ in 86.9% vs 80.4% of those with nonatrial STR; P = 0.005). Although NYHA functional class improved in both STR subetiologies, the symptomatic burden was lower in patients with A-STR at the latest available follow-up (NYHA functional class ≥III in 46% of patients with nonatrial STR vs 38% in those with A-STR; P = 0.033). Beyond that, A-STR was associated with higher 2-year survival rates free from heart failure hospitalization (66.3% [Q1-Q3: 58.2%-75.5%] vs 47.5% [Q1-Q3: 41.7%-54.7%] in patients with nonatrial STR; P < 0.001). Median survival follow-up was 379 days [Q1-Q3: 155-697 days].
CONCLUSIONS
A-STR is a common phenotype of STR and is associated with effective TR reduction and symptomatic reduction after T-TEER.
背景
心房性继发性三尖瓣反流（A-STR）已被认为是继发性三尖瓣反流（STR）的一个重要病因亚型。A-STR患者常采用经导管三尖瓣缘对缘修复术（T-TEER）进行治疗。
目的
本研究旨在评估重度A-STR患者接受T-TEER后的患病率和结局，并将结果与非心房性STR患者进行比较。
方法
本研究纳入了2016年至2022年期间在EuroTR（欧洲经导管三尖瓣反流修复注册研究）注册研究中接受T-TEER治疗STR的患者。A-STR的定义为在右心室功能保留（三尖瓣环平面收缩期位移>17mm）的情况下，收缩末期右心房面积与右心室面积之比≥1.5。主要研究终点是无心力衰竭住院的2年生存率。次要终点包括2年生存率、出院时和1年随访时三尖瓣反流（TR）的减少情况以及纽约心脏协会（NYHA）心功能分级的变化。
结果
本研究纳入了641例患者（50%为女性），平均年龄为79±7岁。A-STR的总体患病率为31%（n = 196）。A-STR与心房颤动的患病率较高、合并症较少、双心室功能较好、瓣叶帐篷样改变较少以及心房较大有关。尽管基线时TR严重程度相当，但A-STR患者的手术TR减少效果更显著（TR≤2+的患者中，A-STR组为86.9%，非心房性STR组为80.4%；P = 0.005）。尽管两种STR亚型的NYHA心功能分级均有所改善，但在最近一次随访时，A-STR患者的症状负担较低（非心房性STR患者中46%的患者NYHA心功能分级≥III级，A-STR患者中为38%；P = 0.033）。除此之外，A-STR与无心力衰竭住院的较高2年生存率相关（非心房性STR患者为47.5%[四分位间距：41.7%-54.7%]，A-STR患者为66.3%[四分位间距：58.2%-75.5%]；P < 0.001）。中位生存随访时间为379天[四分位间距：155-697天]。
结论
A-STR是STR的一种常见表型，与T-TEER术后有效的TR减少和症状减轻相关。
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