Atrial-secondary tricuspid regurgitation: a better prognosis in early stage heart failure, but not in late stage

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Corentin Bourg, K. Charlotte Lee Frost, Augustin Coisne, Elizabeth Curtis, Guillaume L'official, Yoan Lavie-Badie, Léo Lemarchand, Julien Dreyfus, Emmanuel Oger, Erwan Donal
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引用次数: 0

Abstract

Background and Aims

Although the classification of secondary tricuspid regurgitation (STR) by atrial or ventricular aetiology (A-STR or V-STR) carries prognostic importance, the confounding effects of New York Heart Association (NYHA) class have not yet been elucidated. We aimed to correlate STR and NYHA classification with patient outcomes.

Methods

We studied 281 patients with severe STR who presented to 16 French hospitals between 2017 and 2019. Patients were separated into A-STR and V-STR categories using echocardiographic criteria (A-STR = tricuspid tenting height ≤10 mm, right mid-ventricular diameter ≤38 mm, and LVEF ≥ 50%). We tracked time to cardiovascular disease-related hospitalization or death, whichever came first.

Results

Of the patients 91/281 (32.7%) had A-STR, 164/281 (58.4%) had mixed/V-STR, and 25/281 (8.9%) could not be classified. Baseline age, labs, comorbidities and NYHA category (Class I–II = mildly symptomatic, Class III–IV = very symptomatic) did not differ between groups (P > 0.05). Although there were no differences in event-free survival among groups (70.7% vs. 65.9%, P = 0.59), this was confounded by NYHA class (P = 0.0104). Thus, among mildly symptomatic patients, estimated 5 year event-free survival was 76.4% in the A-STR group and 53.2% in the mixed/V-STR group (P < 0.05). Among very symptomatic patients, there was no difference in estimated event-free survival (39.4% vs. 17.2%, P > 0.05).

Conclusions

Though A-STR carries a more favourable prognosis in mildly symptomatic patients, this distinction is irrelevant in patients with advanced disease. Thus, the value of tricuspid valve intervention may become ‘too little, too late’ if A-STR is not promptly addressed.

Abstract Image

心房继发性三尖瓣反流:早期心力衰竭预后较好,但晚期预后不佳。
背景和目的:虽然继发性三尖瓣反流(STR)的心房或心室病因(A-STR或V-STR)分类具有预后重要性,但纽约心脏协会(NYHA)分类的混淆效应尚未阐明。我们的目的是将STR和NYHA分类与患者预后联系起来。方法:我们研究了2017年至2019年在法国16家医院就诊的281例严重STR患者。采用超声心动图标准将患者分为A-STR和V-STR两组(A-STR =三尖瓣支架高度≤10 mm,右中心室直径≤38 mm, LVEF≥50%)。我们追踪时间到与心血管疾病相关的住院或死亡,以先发生者为准。结果:91/281例(32.7%)为a型str, 164/281例(58.4%)为混合型/ v型str, 25/281例(8.9%)无法分型。基线年龄,实验室,合并症和NYHA分类(I-II级=轻度症状,III-IV级=非常症状)在组间无差异(P < 0.05)。虽然各组间无事件生存率无差异(70.7% vs. 65.9%, P = 0.59),但NYHA分类混淆了这一点(P = 0.0104)。因此,在轻度症状患者中,A-STR组的5年无事件生存率为76.4%,混合/V-STR组为53.2% (P < 0.05)。结论:尽管a - str在轻度症状患者中预后较好,但这种区别与晚期疾病患者无关。因此,如果A-STR得不到及时处理,三尖瓣介入治疗的价值可能会变得“太小、太晚”。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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