射血分数保留的三尖瓣反流合并心力衰竭患者的管理
Management of Patient With Tricuspid Regurgitation and Heart Failure With Preserved Ejection Fraction.
作者信息
Bartkowiak Joanna, Agarwal Vratika, Otero Diana, Pinheiro Rezende Carolina, Hahn Rebecca T
机构信息
Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA; University of California, San Diego, California, USA.
出版信息
JACC Case Rep. 2025 Mar 19;30(6 Pt 2):103287. doi: 10.1016/j.jaccas.2025.103287.
BACKGROUND
Heart failure with preserved ejection fraction (HFpEF) and tricuspid regurgitation are increasingly recognized as interrelated conditions with overlapping management approaches.
CASE SUMMARY
A 69-year-old woman presented with worsening palpitations and exertional dyspnea. Her symptoms, in combination with a preserved ejection fraction and evidence of increased left ventricular filling pressures, were indicative of HFpEF. Echocardiographic examination revealed torrential tricuspid regurgitation. Guideline-directed medical therapy was optimized, resulting in improvement of tricuspid regurgitation severity.
DISCUSSION
Recent guidelines for HFpEF management emphasize the use of diuretics for symptom control and the addition of sodium-glucose cotransporter 2 inhibitors and sacubitril-valsartan to improve outcomes. The case underscores the importance of addressing the underlying hemodynamic contributors to tricuspid regurgitation before considering surgical or catheter-based interventions.
TAKE-HOME MESSAGES: Guideline-directed medical therapy for HFpEF plays a crucial role in symptom relief, improves outcomes, and may help reduce tricuspid regurgitation severity.
背景
射血分数保留的心力衰竭（HFpEF）和三尖瓣反流越来越被认为是相互关联的疾病，治疗方法有重叠。
病例摘要
一名69岁女性因心悸和劳力性呼吸困难加重就诊。她的症状，结合保留的射血分数和左心室充盈压升高的证据，提示为HFpEF。超声心动图检查显示重度三尖瓣反流。优化了指南指导的药物治疗，三尖瓣反流严重程度得到改善。
讨论
最近关于HFpEF管理的指南强调使用利尿剂控制症状，并加用钠-葡萄糖协同转运蛋白2抑制剂和沙库巴曲缬沙坦以改善预后。该病例强调了在考虑手术或导管介入治疗之前，解决导致三尖瓣反流的潜在血流动力学因素的重要性。
要点
指南指导的HFpEF药物治疗在缓解症状方面起着关键作用，可改善预后，并可能有助于降低三尖瓣反流严重程度。
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