三尖瓣反流中右心室-肺动脉耦合：预后价值及治疗策略的影响
Right Ventricular-Pulmonary Artery Coupling in Tricuspid Regurgitation: Prognostic Value and Impact of Treatment Strategy.
作者信息
Rommel Karl-Philipp, Schlotter Florian, Stolz Lukas, Kresoja Karl-Patrik, Kassar Mohammad, Praz Fabien, Estevez-Loureiro Rodrigo, Maisano Francesco, Van Belle Eric, Bonnet Guillaume, Kalbacher Daniel, Ludwig Sebastian, Iliadis Christos, Karam Nicole, Fortmeier Vera, Adamo Marianna, Metra Marco, Stephan von Bardeleben Ralph, Lauten Philipp, Luedike Peter, Raake Philip, Toggweiler Stefan, Boekstegers Peter, Schöber Anne, Rück Andreas, Geisler Tobias, Kessler Mirjam, Konstandin Mathias H, Kister Tobias, Thiele Holger, Lauten Alexander, Hausleiter Jörg, Lurz Philipp
机构信息
Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany; Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Mainz, Germany.
Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Mainz, Germany.
出版信息
JACC Cardiovasc Interv. 2025 Jun 9;18(11):1411-1421. doi: 10.1016/j.jcin.2025.04.033.
BACKGROUND
Right ventricular-pulmonary artery coupling (RVPAC) predicts outcomes after transcatheter tricuspid valve edge-to-edge repair (T-TEER), but its role in patient selection remains unclear.
OBJECTIVES
The aim of this study was to evaluate the prognostic implications of RVPAC in a European registry of patients with tricuspid regurgitation undergoing either T-TEER or medical management.
METHODS
Among 1,885 patients with tricuspid regurgitation (n = 585 medical, n = 1,300 T-TEER), 946 were propensity matched (1:1). RVPAC, assessed as the ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure was analyzed for its association with 1-year mortality.
RESULTS
RVPAC was significantly associated with mortality (HR: 0.11; 95% CI: 0.04-0.29; P < 0.01), with an optimized cutoff of 0.41 mm/mm Hg. Mortality differed significantly by RVPAC in both treatment groups (log-rank P < 0.01). Across RVPAC tertiles (<0.32, 0.32-0.46, and >0.46 mm/mm Hg), tricuspid annular plane systolic excursion increased (14 mm [Q1-Q3: 12-17 mm] vs 18 mm [Q1-Q3: 15-20 mm] vs 21 mm [Q1-Q3: 18-24 mm]; P < 0.01), while systolic pulmonary artery pressure (60 mm Hg [Q1-Q3: 50-70 mm Hg] vs 45 mm Hg [Q1-Q3: 40-52 mm Hg] vs 34 mm Hg [Q1-Q3: 29-41 mm Hg]; P = 0.30) and kidney function (43 mL/min/m [Q1-Q3: 30-57 mL/min/m] vs 49 mL/min/m [Q1-Q3: 38-67 mL/min/m] vs 53 mL/min/m [Q1-Q3: 40-69 mL/min/m]; P = 0.03) declined. Mortality was highest in the low RVPAC tertile, with no difference between treatment modalities (HR: 1.04; 95% CI: 0.68-1.61; P = 0.85). T-TEER was associated with better survival than medical management in the intermediate RVPAC tertile (HR: 0.54; 95% CI: 0.31-0.94; P = 0.03). This difference persisted but weakened in the high RVPAC tertile, with the overall most favorable outcomes (HR: 0.69; 95% CI: 0.35-1.36; P = 0.27).
CONCLUSIONS
Poorer RVPAC reflects higher baseline risk and mortality, regardless of treatment. T-TEER is associated with better survival across a range of RVPAC values, including those less than previously suggested thresholds.
背景
右心室-肺动脉耦合（RVPAC）可预测经导管三尖瓣缘对缘修复术（T-TEER）后的预后，但它在患者选择中的作用仍不明确。
目的
本研究旨在评估RVPAC在欧洲一项三尖瓣反流患者登记研究中的预后意义，这些患者接受了T-TEER或药物治疗。
方法
在1885例三尖瓣反流患者中（585例接受药物治疗，1300例接受T-TEER），946例进行了倾向匹配（1:1）。分析RVPAC（评估为三尖瓣环平面收缩期位移与收缩期肺动脉压之比）与1年死亡率的相关性。
结果
RVPAC与死亡率显著相关（HR：0.11；95%CI：0.04-0.29；P<0.01），最佳截断值为0.41mm/mm Hg。两个治疗组中，RVPAC不同，死亡率有显著差异（对数秩检验P<0.01）。在RVPAC三分位数（<0.32、0.32-0.46和>0.46mm/mm Hg）中，三尖瓣环平面收缩期位移增加（14mm[第一四分位数-第三四分位数：12-17mm]对18mm[第一四分位数-第三四分位数：15-20mm]对21mm[第一四分位数-第三四分位数：18-24mm]；P<0.01），而收缩期肺动脉压（60mm Hg[第一四分位数-第三四分位数：50-70mm Hg]对45mm Hg[第一四分位数-第三四分位数：40-52mm Hg]对34mm Hg[第一四分位数-第三四分位数：29-41mm Hg]；P=0.30）和肾功能（43mL/min/m[第一四分位数-第三四分位数：30-57mL/min/m]对49mL/min/m[第一四分位数-第三四分位数：38-67mL/min/m]对53mL/min/m[第一四分位数-第三四分位数：40-69mL/min/m]；P=0.03）下降。低RVPAC三分位数组的死亡率最高，治疗方式之间无差异（HR：1.04；95%CI：0.68-1.61；P=0.85）。在中等RVPAC三分位数组中，T-TEER与比药物治疗更好的生存率相关（HR：0.54；95%CI：0.31-0.94；P=0.03）。这种差异在高RVPAC三分位数组中持续存在但减弱，总体预后最有利（HR：0.69；95%CI：0.35-1.36；P=0.27）。
结论
RVPAC较差反映了较高的基线风险和死亡率，与治疗无关。在一系列RVPAC值范围内，包括那些低于先前建议阈值的值，T-TEER与更好的生存率相关。
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