三尖瓣反流的诊断和治疗。

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Thomas J Stocker, Christian Besler, Hendrik Treede, Jörg Hausleiter
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引用次数: 0

摘要

背景:据估计,在 75 岁以上的老年人中,有 6% 的人患有临床相关的三尖瓣反流 (TR)。这种疾病的死亡率很高,而且由于最近开发出了新的介入治疗方法,因此特别引人关注:本综述基于在 PubMed 数据库中选择性检索的随机对照试验 (RCT)、观察性研究、登记研究、专家建议和当前国际指南中的出版物:结果:证据显示,TR 是导致死亡的一个独立原因。死亡率与 TR 的严重程度相关:约 35% 的严重 TR 和右心衰竭患者在 1 年内死亡,约 60% 的患者在 3 年内死亡。临床病程因病因(原发性 TR、房性/室性继发性 TR、与起搏器系统有关)而异。在门诊环境中,通过经胸超声心动图及时诊断至关重要。药物治疗的选择基本上仅限于利尿剂治疗(2a 级推荐)。尽早转诊到专业的心脏瓣膜中心对于预防右心不可逆损伤和继发性内脏损伤(包括心肝和心肾综合征)至关重要。在心脏瓣膜中心,通过多模态成像进行扩展诊断评估后,由跨学科心脏团队进行病例讨论,并对治疗方案进行单独评估。首例治疗 TR 的随机对照试验结果显示,介入治疗(边缘到边缘修补术)与最佳药物治疗相比,胜率为 1.48(95% 置信区间,[1.06; 2.13]):结论:随着人们对三尖瓣反流的认识不断加深,介入治疗三尖瓣反流的策略也在稳步发展,目的是降低这种疾病的死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Diagnosis and Treatment of Tricuspid Regurgitation.

Background: It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments.

Methods: This review is based on publications that were retrieved by a selective search in the PubMed database for randomized controlled trials (RCTs), observational studies, registry studies, expert recommendations, and current international guidelines.

Results: The evidence reveals that TR is an independent cause of mortality. Mortality is correlated with the severity of TR: approximately 35% of patients with severe TR and right heart failure die within 1 year, and about 60% within 3 years. The clinical course varies depending on the etiology (primary TR, atrial/ventricular secondary TR, association with pacemaker systems). In the outpatient setting, timely diagnosis by transthoracic echocardiography is crucial. The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. In the heart valve center, an extended diagnostic evaluation with multimodal imaging is followed by a case discussion by the interdisciplinary cardiac team, with individual evaluation of the treatment options. The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy.

Conclusion: As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.

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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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