Kitamura Mitsunobu, Amami Kazuaki, Yaguchi Tomoyuki, Okabe Kouya, Shiraishi Yasuyuki, Nakamaru Ryo, Nagatomo Yuji, Goda Ayumi, Nomoto Michiru, Mizuno Atsushi, Sakamoto Munehisa, Ichihara Yumiko K, Kohno Takashi, Kohsaka Shun, Yoshikawa Tsutomu
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
JACC Adv. 2025 May 26;4(6 Pt 1):101832. doi: 10.1016/j.jacadv.2025.101832.
Left-sided heart disease is the leading etiology of tricuspid regurgitation (TR) in heart failure (HF); however, the association between different HF phenotypes and the adverse effects of TR remains unclear.
The authors aimed to elucidate the association between TR and outcomes across the subtypes of left-sided heart disease in patients hospitalized for HF.
We analyzed data from the multicenter West Tokyo Heart Failure registry between January 2006 and December 2021. Moderate or severe mitral or aortic valve disease was defined as left-sided valve dysfunction (LVD). Patients with congenital heart disease, secondary cardiomyopathy, systemic conditions related to HF, or those with incomplete datasets were excluded. Using a multivariable Cox hazard model, the survival effect of TR on mortality in patients with LVD was examined.
Overall, 3,040 presented with LVD (median age, 80 years; 45.9% female), and 2,438 had no LVD (median age, 74 years; 27.8% female). The prevalence of moderate and severe TR was 27.6% and 6.5% in patients with LVD and 9.2% and 1.5% in those without LVD, respectively. The adjusted HRs of moderate and severe TR for mortality were 1.25 (95% CI: 1.03-1.52) and 1.72 (95% CI: 1.30-2.29) in those with LVD, respectively, and 2.15 (95% CI: 1.62-2.84) and 3.09 (95% CI: 1.87-5.09) in those without LVD, respectively. Significant interactions between the subtypes were observed (P = 0.005).
TR severity stratified mortality after acute decompensated HF better in patients without LVD than in those with LVD.
在心力衰竭（HF）中，左侧心脏病是三尖瓣反流（TR）的主要病因；然而，不同HF表型与TR不良影响之间的关联仍不清楚。
作者旨在阐明因HF住院患者中TR与左侧心脏病各亚型预后之间的关联。
我们分析了2006年1月至2021年12月期间多中心东京西部心力衰竭登记处的数据。中度或重度二尖瓣或主动脉瓣疾病被定义为左侧瓣膜功能障碍（LVD）。排除患有先天性心脏病、继发性心肌病、与HF相关的全身性疾病或数据集不完整的患者。使用多变量Cox风险模型，研究TR对LVD患者死亡率的生存影响。
总体而言，3040例有LVD（中位年龄80岁；45.9%为女性），2438例无LVD（中位年龄74岁；27.8%为女性）。有LVD患者中中度和重度TR的患病率分别为27.6%和6.5%，无LVD患者中分别为9.2%和1.5%。有LVD患者中，中度和重度TR死亡的校正风险比分别为1.25（95%CI：1.03 - 1.52）和1.72（95%CI：1.30 - 2.29），无LVD患者中分别为2.15（95%CI：1.62 - 2.84）和3.09（95%CI：1.87 - 5.09）。观察到各亚型之间存在显著交互作用（P = 0.005）。
与有LVD的患者相比，TR严重程度在无LVD的急性失代偿性HF患者中对死亡率的分层效果更好。
