Soongu Kwak, Dong-Jae Han, Seung-Pyo Lee, Ho Young Hwang, Hyung-Kwan Kim, Yong-Jin Kim, Kyung Hwan Kim, Jae Woong Choi, Jun-Bean Park
{"title":"严重心房功能性三尖瓣反流患者右心房重构与预后。","authors":"Soongu Kwak, Dong-Jae Han, Seung-Pyo Lee, Ho Young Hwang, Hyung-Kwan Kim, Yong-Jin Kim, Kyung Hwan Kim, Jae Woong Choi, Jun-Bean Park","doi":"10.1002/ehf2.15301","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a distinct cause of tricuspid regurgitation, yet data on outcomes and their determinants are limited. This study examines the prognostic role of right atrial (RA) remodelling in patients with severe AFTR.</p>\n </section>\n \n <section>\n \n <h3> Methods and results</h3>\n \n <p>This retrospective study included consecutive patients with severe AFTR. The primary outcome was all-cause mortality. Cutoff values for RA and right ventricular (RV) sizes related to mortality were identified using receiver operating characteristic curves and maximally selected rank statistics. The cohort included 155 patients with severe AFTR, 96.1% of whom had atrial fibrillation. Of these, 121 received medical treatment, and 34 underwent surgery during follow-up. In the medical management group, 42 deaths (34.7%) occurred over a median of 3.3 years. Patients with high RV end-diastolic area and RA area indices (>14.5 cm<sup>2</sup>/m<sup>2</sup> and >22 cm<sup>2</sup>/m<sup>2</sup>) had significantly lower survival compared to their counterparts (<i>P</i> = 0.012 and P = 0.001, respectively). Cox analyses demonstrated that increased RV end-diastolic area and RA area indices were associated with higher mortality (RV end-diastolic area index, per 1 cm<sup>2</sup>/m<sup>2</sup> increase: adjusted hazard ratio 1.11, 95% confidence interval 1.02–1.22, <i>P</i> = 0.019; RA area index, per 1 cm<sup>2</sup>/m<sup>2</sup> increase: adjusted hazard ratio 1.06, 95% confidence interval 1.02–1.10, <i>P</i> = 0.006). Mortality was highest in patients with both high RV end-diastolic area index (>14.5 cm<sup>2</sup>/m<sup>2</sup>) and RA area index (>22 cm<sup>2</sup>/m<sup>2</sup>) and lowest in those with low values for both indices (<i>P</i> = 0.001). In the surgical intervention group, four post-surgical deaths (11.8%) occurred exclusively in patients with both high RA area and RV end-diastolic area indices.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>RA and RV enlargement are poor prognostic factors in patients with severe AFTR. These findings underscore the importance of assessing RA and RV remodelling to optimize the timing of intervention in this population.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2909-2920"},"PeriodicalIF":3.7000,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15301","citationCount":"0","resultStr":"{\"title\":\"Right atrial remodelling and prognosis in patients with severe atrial functional tricuspid regurgitation\",\"authors\":\"Soongu Kwak, Dong-Jae Han, Seung-Pyo Lee, Ho Young Hwang, Hyung-Kwan Kim, Yong-Jin Kim, Kyung Hwan Kim, Jae Woong Choi, Jun-Bean Park\",\"doi\":\"10.1002/ehf2.15301\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a distinct cause of tricuspid regurgitation, yet data on outcomes and their determinants are limited. This study examines the prognostic role of right atrial (RA) remodelling in patients with severe AFTR.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods and results</h3>\\n \\n <p>This retrospective study included consecutive patients with severe AFTR. The primary outcome was all-cause mortality. Cutoff values for RA and right ventricular (RV) sizes related to mortality were identified using receiver operating characteristic curves and maximally selected rank statistics. The cohort included 155 patients with severe AFTR, 96.1% of whom had atrial fibrillation. Of these, 121 received medical treatment, and 34 underwent surgery during follow-up. In the medical management group, 42 deaths (34.7%) occurred over a median of 3.3 years. Patients with high RV end-diastolic area and RA area indices (>14.5 cm<sup>2</sup>/m<sup>2</sup> and >22 cm<sup>2</sup>/m<sup>2</sup>) had significantly lower survival compared to their counterparts (<i>P</i> = 0.012 and P = 0.001, respectively). Cox analyses demonstrated that increased RV end-diastolic area and RA area indices were associated with higher mortality (RV end-diastolic area index, per 1 cm<sup>2</sup>/m<sup>2</sup> increase: adjusted hazard ratio 1.11, 95% confidence interval 1.02–1.22, <i>P</i> = 0.019; RA area index, per 1 cm<sup>2</sup>/m<sup>2</sup> increase: adjusted hazard ratio 1.06, 95% confidence interval 1.02–1.10, <i>P</i> = 0.006). Mortality was highest in patients with both high RV end-diastolic area index (>14.5 cm<sup>2</sup>/m<sup>2</sup>) and RA area index (>22 cm<sup>2</sup>/m<sup>2</sup>) and lowest in those with low values for both indices (<i>P</i> = 0.001). In the surgical intervention group, four post-surgical deaths (11.8%) occurred exclusively in patients with both high RA area and RV end-diastolic area indices.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>RA and RV enlargement are poor prognostic factors in patients with severe AFTR. These findings underscore the importance of assessing RA and RV remodelling to optimize the timing of intervention in this population.</p>\\n </section>\\n </div>\",\"PeriodicalId\":11864,\"journal\":{\"name\":\"ESC Heart Failure\",\"volume\":\"12 4\",\"pages\":\"2909-2920\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-04-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15301\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ESC Heart Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15301\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ESC Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15301","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Right atrial remodelling and prognosis in patients with severe atrial functional tricuspid regurgitation
Aims
Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a distinct cause of tricuspid regurgitation, yet data on outcomes and their determinants are limited. This study examines the prognostic role of right atrial (RA) remodelling in patients with severe AFTR.
Methods and results
This retrospective study included consecutive patients with severe AFTR. The primary outcome was all-cause mortality. Cutoff values for RA and right ventricular (RV) sizes related to mortality were identified using receiver operating characteristic curves and maximally selected rank statistics. The cohort included 155 patients with severe AFTR, 96.1% of whom had atrial fibrillation. Of these, 121 received medical treatment, and 34 underwent surgery during follow-up. In the medical management group, 42 deaths (34.7%) occurred over a median of 3.3 years. Patients with high RV end-diastolic area and RA area indices (>14.5 cm2/m2 and >22 cm2/m2) had significantly lower survival compared to their counterparts (P = 0.012 and P = 0.001, respectively). Cox analyses demonstrated that increased RV end-diastolic area and RA area indices were associated with higher mortality (RV end-diastolic area index, per 1 cm2/m2 increase: adjusted hazard ratio 1.11, 95% confidence interval 1.02–1.22, P = 0.019; RA area index, per 1 cm2/m2 increase: adjusted hazard ratio 1.06, 95% confidence interval 1.02–1.10, P = 0.006). Mortality was highest in patients with both high RV end-diastolic area index (>14.5 cm2/m2) and RA area index (>22 cm2/m2) and lowest in those with low values for both indices (P = 0.001). In the surgical intervention group, four post-surgical deaths (11.8%) occurred exclusively in patients with both high RA area and RV end-diastolic area indices.
Conclusions
RA and RV enlargement are poor prognostic factors in patients with severe AFTR. These findings underscore the importance of assessing RA and RV remodelling to optimize the timing of intervention in this population.
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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